Abstract
One of the key points of a successful rhinoplasty is communication between the patient
and surgeon. The surgeon needs to get a clear understanding of the patient's motivation
for surgery and expectations of the procedure. This information is mandatory in formulating
an optimal surgical plan and managing realistic expectations of the procedures. Ideally,
surgeons and patients see, discuss, and quantify the same nasal defects. In reality,
the subjective nature of perceiving aesthetics can cause variability of inter-rating
nasal appearance. Therefore, one might question how well surgeons understand their
patients. Do they see what patients see? The aim of this study is to assess the level
of agreement on the evaluation of nasal appearance between patients, surgeons, and
nonphysicians observers, and try to find predictive factors that cause high interobserver
variability. This prospective, observational, and cross-sectional study was performed
on a total of 100 randomized patients undergoing rhinoplasty. All patients were photographed
before surgery and asked to rate the appearance of their nose on a 10 cm visual analogue
scale (VAS) with 0 indicating very ugly and 10 indicating very nice. Subsequently,
the photographs of each patient were, independently, rated by two panels: one constituted
by two rhinoplasty surgeons and the other by four nonmedical raters. Both panels included
European raters from the north (The Netherlands) and south (Portugal). Data regarding
age, gender, skin type, and major nasal deformity were also collected. The authors
found that there is no statistical agreement between the aesthetical evaluation of
the nose between patients and surgeons or patients and nonmedical raters. Based exclusively
on the VAS for subjective evaluation of nasal appearance, the authors' findings show
that surgeons and patients do not “see the same” and generally, the score attributed
by the surgeon is more favorable (almost 1 point higher) than the auto-assessment's
score. This is important to realize when communicating about nasal appearance before
rhinoplasty.
Keywords
rhinoplasty - aesthetic - aesthetical perception - self-assessment - rhinoplasty outcome
