Psychological evaluation of Asian female patients with rhinoplasty.

BACKGROUND: Patients requiring plastic surgery exhibit more abnormal psychological trends (e.g., body dysmorphic disorder [BDD], depression, and anxiety) than those requiring other surgeries. However, there are only a few domestic studies on the psychological aspects of the population requiring plastic surgery. Therefore, we analyzed the psychological characteristics and psychological impact of rhinoplasty in female patients. METHODS: In this study, patients were classified into 2 groups: 151 males and 60 females. The self-rating scale of body image (SSBI), self-rating anxiety scale, self-rating depression scale, and postoperative satisfaction questionnaire were used to examine the patients before and after surgery. The results were analyzed using t-test, analysis of variance, chi-square test, paired rank sum test, and Pearson correlation analysis. RESULTS: The total prevalence of BDD in female patients who underwent rhinoplasty was 7.3%. The prevalence of anxiety disorders was 31.8% and that of depression was 45.0%. Female patients with BDD were more likely to exhibit depression (55.5%) and anxiety (36.4%). The SSBI score was related to marital status (p = 0.001) and history of rhinoplasty (p = 0.000). Moreover, there was a significant negative correlation between preoperative BDD score and postoperative satisfaction (r = -0.392, p = 0.002) as well as between the previous history of rhinoplasty and postoperative satisfaction (r = -0.603, p = 0.000). CONCLUSION: Pathological psychologies such as anxiety, depression, and BDD are common in patients scheduled to undergo rhinoplasty, and BDD is more likely to be associated with depression. Rhinoplasty has little psychological impact on patients, i.e., it neither causes improvement nor deterioration. Female patients who have undergone rhinoplasty should be considered to a have high risk of BDD. Although the outcomes of surgery are generally quite positive, patients diagnosed with BDD are more likely to be dissatisfied.

Quality of Life and Screening on Body Dysmorphic Disorder, Depression, Anxiety in Septorhinoplasty.

OBJECTIVES: Septorhinoplasty (SRPL) can improve quality of life (QoL) in functional and aesthetical aspects of the nose. A key factor compromising postoperative satisfaction is symptoms of body dysmorphic disorder (BDD), defined by excessive concerns and distress over slight or imagined physical defects. Although a high prevalence of BDD in SRPL patients is evident, the effect of positive screening on BDD and other psychiatric disorders is understudied. It was hypothesized that patients screening positive for BDD, depression or anxiety do not show increased postoperative QoL. METHODS: A multicenter, prospective study including 259 patients. For psychiatric evaluation, the BDD concern questionnaire-aesthetic version and the Hospital Anxiety and Depression Scale were used; for disease-specific QoL the Rhinoplasty Outcomes Evaluation (ROE) and the Functional Rhinoplasty Outcome Inventory (FROI-17). RESULTS: In preoperative evaluation, 32.5% had a positive screening for BDD, 42.2% for increased anxiety, and 32.9% for depression. Mean QoL improved in the whole cohort (FROI total score: 54.4 ± 21.8 to 32.8 ± 23.7 and ROE: 32.3 ± 15.6 to 69.8 ± 23.1, both p < 0.001). Patients screening positive for BDD, depression or anxiety did show an increased postoperative QoL, but to a significantly lower degree and with lower pre- and postoperative QoL levels. CONCLUSIONS: SRPL patients show a high prevalence of BDD symptoms, elevated anxiety, and depression. These subgroups show lower QoL levels and an impaired QoL increase after surgery. Rhinoplasty surgeons must be aware of the disorders and their symptoms, discuss potential concerns with the patients, and potentially refer them to a specialist. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:2187-2193, 2024.

The heart of it all: Body dysmorphic disorder in cosmetic surgery.

BACKGROUND: Body Dysmorphic Disorder (BDD) represents a prevalent mental health condition characterized by distress arising from self-perceived physical imperfections. BDD serves as a contraindication to aesthetic surgery. Recognizing BDD holds paramount importance for plastic surgeons, as it is instrumental in averting the exacerbation of this condition while ensuring appropriate referrals. OBJECTIVE: This study aimed to investigate the prevalence of BDD in cosmetic surgery patients and to pinpoint key characteristics associated with BDD. This information provides plastic surgeons with specific factors to consider during preoperative evaluations. METHODS: We employed TriNetX database to identify patients with BDD who underwent cosmetic surgery identified by Current Procedural Terminology codes. Demographics and patient characteristics were identified using the International Classification of Diseases 10 codes. We calculated odds ratios (OR) by using chi-squared tests to assess risk factors among patients with BDD. RESULTS: Of 226,374 patients who underwent plastic surgery between August 2002 and August 2022, fewer than 0.1% were diagnosed with BDD. Of the BDD patients, 52.1% were diagnosed after cosmetic surgery. Compared with the control group, BDD patients were more likely to undergo rhinoplasty (OR=1.784, p = 0.004) and nonlocalized lipectomy (OR=1.448, p = 0.021) and less likely to undergo blepharoplasty (OR=0.451, p = 0.002). Findings indicated a strong association between BDD patients undergoing cosmetic procedures and comorbid psychiatric conditions such as depression (OR=4.279, p < 0.05), anxiety (OR=5.490, p < 0.05), and Attention-Deficit Hyperactivity Disorder (OR=3.993, p < 0.05). CONCLUSIONS: These findings underscore the ongoing significance of BDD in the context of cosmetic surgery, potentially indicating a lower surgery rate among BDD patients compared with previous estimates. Nevertheless, avenues for further improvement persist. Our data affirm the noteworthy occurrence of postsurgery BDD development, thereby highlighting the ongoing necessity for psychiatric evaluation in surgical patients.

Assessing outcomes from rhinoplasty using clinical and patient reported measures (FACE-Q™).

AIM: To assess the effect of cosmetic rhinoplasty on PROMS using the FACE-Q™ tool. METHODS: Between July 2020 and February 2022 all patients undergoing rhinoplasty by a single surgeon were approached pre-operatively and 6 months post-operatively to complete the Face-Q™ "Satisfaction with Nose" module. Post-operative patients were asked to complete the FACE-Q™ "Satisfaction with Outcome" module. RESULTS: One hundred and sixty-five patients underwent rhinoplasty (147 primary, 18 revisions). Eighty two percent (n = 135) completed a pre-operative "Satisfaction with Nose" module. Thirty three percent (n = 54) completed the full pre and post- operative dataset. The mean pre-operative "Satisfaction with Nose" score was 32.88 (± 8.40). The mean post-operative "Satisfaction with Nose" score was 77.45 (SD17.26) and "Satisfaction with Outcome" score was 75.27(SD 21.88). The mean change in score 133% (SD 63%). Seventy-seven percent of patients were "very satisfied" or "somewhat satisfied" across all 10 aspects of the nose. The tip had the lowest post-operative satisfaction with 19% of patients somewhat or very dissatisfied. CONCLUSION: Rhinoplasty generates significant improvements in PROMS and satisfaction is high, an important positive finding for patients considering surgery. Routine collection of PROMS for rhinoplasty can inform practice and guide expectations as to its psychological impact.

Novel Selection Tools in Rhinoplasty Patients.

With no consensus document or guideline to help us compute the psychological make-up of rhinoplasty candidates and in the light of new perspectives of some key opinion leaders in the field of patient selection, the goals of this article are to offer a glimpse of the current literature together with the knowledge gaps, introduce some new tools for the preoperative consultation, help us identify who among our patients is at greatest risk for a poor outcome, and explain how childhood trauma can be linked to body shame and postoperative dissatisfaction.

The relationship between alexithymia and clinical features in rhinoplasty patients.

OBJECTIVE: The present study aimed to investigate the incidence of alexithymia in rhinoplasty patients before and after surgery, and to increase the value of alexithymia analysis. The study also aimed to evaluate self-esteem and rhinoplasty outcome scores together. MATERIAL AND METHODS: Patients who had undergone rhinoplasty were enrolled in the study, and they were grouped according to gender, marital status, working status, indication (functional or aesthetic), and type of surgery (primary or revision). Toronto Alexithymia Scale-20 (TAS-20), Rosenberg Self-Esteem Scale (RSES), Rhinoplasty Outcome Evaluation (ROE), and Nasal Obstruction Symptom Evaluation (NOSE) surveys were used to assess their relationship with alexithymia. RESULTS: We observed significantly higher alexithymia and lower self-esteem scores in females, widows, those with aesthetic indication, those who required revision surgery, and those who had never worked, and a significant correlation was observed except for marital status (p<0.05). After the surgery, significant improvement was found in TAS-20 and RSES according to preoperative scores (p<0.05). There was a significant inverse correlation between TAS-20 and ROE scores, while a positive correlation was observed between RSES and ROE scores (p<0.05). CONCLUSION: This is the first study to investigate alexithymia changes in rhinoplasty candidates. TAS-20 can be considered as a useful survey to assess psychological distress in rhinoplasty candidates.

Body Dysmorphic and Narcissistic Personality Disorder in Cosmetic Rhinoplasty Candidates.

BACKGROUND: Body dysmorphic disorder (BDD) and other psychological problems are more common in cosmetic surgery applicants. OBJECTIVE: The aim of this study was to investigate the frequency of the symptoms of BDD and narcissistic personality disorder in rhinoplasty candidates. MATERIALS AND METHODS: This descriptive cross-sectional study was performed on rhinoplasty applicants. All subjects were evaluated by BDD and narcissistic personality questionnaires (NPI-16). RESULTS: A total of 380 patients were studied. Our findings showed that the prevalence of mild, moderate, and severe BDD symptoms was 31.6%, 43.4% and 25%, respectively. The mean BDD scores were not significantly different in variables such as gender, age, marital status, history of cosmetic surgery, education, place of residence, and income. 29.5% of the subjects had symptoms of narcissism. There was no significant relationship between the symptoms of narcissism and variables such as gender, age, marital status, history of cosmetic surgery, place of residence, and income. Higher education was associated with higher rates of narcissistic personality disorder (p-value = 0.021). CONCLUSIONS: According to the results of the study, there was no statistically significant relationship between BDD score and demographic parameters. Also, association between narcissistic personality disorder and demographic characteristics was not significant except for education. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Factors Involved in the Decision of Iranian Men to Undergo Rhinoplasty: A Grounded Theory Study.

Undergoing a rhinoplasty can affect an individual's mental health either positively or negatively, depending upon how he or she perceives the results. Because of the impact that rhinoplasty may have on an individual's mental health and the cost of this surgery, it is important to understand the reasons that men decide to undergo rhinoplasty and the challenges they face when making the decision to have a rhinoplasty. Using a grounded theory method, we collected data by conducting interviews with 20 participants. We analyzed the data and initially obtained 684 initial codes. After we removed duplicate codes and carefully analyzed participants' interviews, a total of 497 codes remained. We developed these codes into 10 main categories and 32 subcategories. We found that the causal factors affecting the decision of Iranian men to undergo rhinoplasty included the following 5 categories: a lack of confidence; a desire to improve their appearance; a desire for attention from others; a need to keep up with the Joneses (i.e., a desire to show that one is as good as other people by getting what others have and doing what others do); and persuasion by others. Intervening factors affecting the decision of Iranian men to undergo rhinoplasty included the following 4 categories: family challenge; social atmosphere; financial problems; and unwanted consequences. Iranian men make the decision to undergo rhinoplasty by overcoming and ignoring these intervening factors. The primary variable in participants' decision to undergo rhinoplasty was the desire to improve their appearance.

Impact of Psychologic Burden on Surgical Outcome in Empty Nose Syndrome.

OBJECTIVES /HYPOTHESIS: Empty nose syndrome (ENS) is a complicated condition currently thought to be caused by excessive surgical resection of turbinate tissue. Patients with ENS experienced significant psychological symptoms, such as depression and anxiety. This study aimed to evaluate the impact of the psychological burden on the surgical outcome of ENS. STUDY DESIGN: Prospective case series in a tertiary medical center. METHODS: Patients with ENS were prospectively recruited between 2015 and 2018. Validated instruments including the Sinonasal Outcome Test-25 (SNOT-25), Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI) were used to evaluate patients with ENS prior to and 3, 6, and 12 months after nasal reconstruction surgery with submucosal Medpor implantation. RESULTS: A total of 54 ENS patients were enrolled during the study period. All three evaluations revealed significant improvement, and symptoms stabilized 3 months after surgery. Six months post-operatively, SNOT-25 scores were significantly associated with the pre-operative BDI-II and BAI scores (ß = 0.64 and 0.87; P = .006 and <.001, respectively). Multivariate regression model revealed that only BAI scores were significantly associated with the six-month post-operative SNOT-25 scores (adjusted ß = 0.49, P = .036). Moreover, Spearman's correlation found close relationships between the post-operative SNOT-25 and the post-operative BDI-II and BAI scores (rs = 0.751 and 0.884, both P < .001). CONCLUSIONS: Psychological evaluation can help predict surgical outcomes and identify patients with residual disease. These findings emphasize the importance of screening for psychological symptoms and structuring care by including psychological therapy in addition to surgery. LEVEL OF EVIDENCE: 4. Laryngoscope, 131:E694-E701, 2021.

Observer-Reported Outcomes and Cosmetic Procedures: A Systematic Review.

BACKGROUND: Cosmetic procedures have demonstrated beneficial effects on physical appearance based on anatomic markers as well as patient-perceived self-image and quality of life. Recent studies of observer-reported outcomes (OROs) suggest an additional benefit from aesthetic interventions. OBJECTIVE: The authors aimed to review the evidence of OROs from cosmetic procedures performed on the head and neck. PATIENTS, METHODS AND MATERIALS: PubMed, Embase, and Cochrane Library databases were searched for relevant studies, yielding 24 included original investigations. RESULTS: These studies captured 686 total patients, 8,257 observer evaluations, and a variety of interventions including face-lifts, blepharoplasty, rhinoplasty, and minimally invasive treatments including botulinum toxins and hyaluronic acid fillers. Forty-one distinct reported OROs were grouped into 12 descriptive domains. Domains were further grouped into 3 higher-order categories: aesthetics and wellness, social capacities, and skills and competencies. Improved perception after cosmetic intervention is most reproducibly demonstrated for the following ORO domains: age, attractiveness, sociability, relationship success, and occupational and financial competency. CONCLUSION: The synthesized findings imply a tertiary layer of benefit for cosmetic intervention beyond anatomical and patient-centered outcomes through enhanced perceptions of others. These findings may inform the pre-procedure risk-benefit discussion with patients of cosmetic medicine and drive future research into longitudinal outcomes.

Evaluation of Surgical Outcome in Rhinoplasty: A Comparison Between Rasp and Osteotome in Dorsal Hump Removal.

Dorsal hump reduction is a crucial point of rhinoplasty, as it has a great impact on the final shape of nasal pyramid. Depending on morphological features of the hump, its removal is usually obtained by the use of an osteotome or a rasp. In our study, we describe a closed rhinoplasty technique performed in 2 groups of patients: the only difference between the groups is the surgical tools used during the dorsal hump removal phase (rasp vs the 5-mm osteotome).We used 2 questionnaires of quality of life (QoL), Nasal Obstruction Symptom Evaluation (NOSE), and Rhinoplasty Outcome Evaluation (ROE) questionnaire, to evaluate postoperative outcome (6 months after surgery).Closed rhinoplasty was performed in 107 patients. Dorsal hump removal was carried out with rasp on 35 patients; while in 72 cases, it was performed using a 5-mm osteotome. All the patients were given 2 copies of NOSE and ROE questionnaires (1 month before surgery and 6 months after surgery) to evaluate postoperative QoL. In our study emerged that the use of osteotome in dorsal hump reduction is associated with a better aesthetic outcome (evaluated by analyzing patients QoL with ROE questionnaire) without any difference between the 2 groups in terms of functional outcome (expressed by NOSE questionnaire), major and minor complications and surgical procedure duration.

Patient-reported outcome measures in external and endonasal functional septorhinoplasty - A propensity score matching study.

PURPOSE: Patient satisfaction after functional-aesthetic SRP (faSRP) is highly influenced by the cosmetic result of the surgical procedure. Studies that directly evaluate aesthetic success after external and endonasal faSRP are scarce. The objective of this prospective propensity score matching study was to compare patient-reported satisfaction regarding aesthetic perception following faSRP using the external and endonasal approach in a single-institution single-surgeon survey. MATERIALS AND METHODS: Out of 161 patients operated by the senior author between October 2011 and March 2017, propensity score matching (PSM) computed 54 patients each following external (group 1) or endonasal faSRP (group 2). Patients reported their satisfaction with the aesthetic appearance of the nose on a visual analogue scale (VAS, 0-10) and five Likert scale questions using the Utrecht questionnaire three and twelve months after surgery. RESULTS: The mean preoperative VAS score of 3.46 ± 1.06 improved significantly in all patients after faSRP to 4.54 ± 0.38 (F(1.69;157.04) = 634.01, p < 0.001). The VAS increase did not show any correlation to the surgical approach (F(1;93) = 1.12, p = 0.293). The mean aesthetic sum score (5 = low burden up to 25 = high burden) improved significantly from 13.89 ± 3.78 to 8.46 ± 3.63 after three months (t(95) = 14.021, p < 0.001) and remained almost unchanged after 12 months (8.10 ± 3.76; t(98) = 1.450, p = 0.150) irrespective of the surgical approach (F(1,544;143,587) = 0.126, p = 0.829). CONCLUSIONS: Both the external and endonasal faSRP allowed for significant improvement in patient's aesthetic self-assessment of similar extent.

Epithetic nasal reconstruction after total rhinectomy: Oncologic outcomes, immediate and long-term adverse effects, and quality of life.

INTRODUCTION: Total rhinectomy for tumors of the nasal cavity substantially alters patients' appearance and requires local reconstruction. While full nasal epitheses are well-established for this purpose, potential long-term adverse effects and impact on patients' quality of life are not fully understood. METHODS: Sixteen patients who underwent total rhinectomy with ensuing nasal reconstruction with a full nasal epithesis were included in the study. Oncologic outcomes were assessed, and adverse effects and quality of life analyses were performed based on a patient-reported outcomes tool. RESULTS: In patients with squamous cell carcinomas of the nasal cavity, total rhinectomy led to excellent local tumor control. Immediate and long-term adverse effects of total rhinectomy and placement of a nasal epithesis were predominantly limited to the immediate nasal region. While patients were satisfied with their nasal appearance, they reported a worse assessment of their facial appearance and a measurable long-term effect on their psychological well-being. CONCLUSION: Total rhinectomy and reconstruction with a full nasal epithesis is a safe and oncologically sound treatment approach. However, its effects on patients' overall appearance and psychological well-being need to be considered during treatment planning and follow-up.

Psychiatric Disorders in Facial Plastic Surgery.

Body dysmorphic disorder and borderline personality disorder are common in esthetic practices and occur in up to 15% of patients. Operating on these patients may not only lead to dissatisfaction but may also worsen their premorbid condition and can induce negative behavior toward the practice. Preventing surgery and referring patients for cognitive therapy is essential. An adequate understanding of these conditions and the available screening tools is indispensable for all esthetic practitioners. Unrealistic emotional attribution to a facial shape, multiple procedures, a near-normal nose at the outset, childhood trauma, multiple comorbid mental conditions, and social dysfunction are red-flags to consider.

The Health Utility and Valuation of Cosmetic Rhinoplasty.

Importance: The importance of this study is to understand the impact of rhinoplasty as perceived by society and to conceptualize the health utility metric of cosmetic rhinoplasty in relation to other health interventions. Objective: This novel study seeks to measure and quantify the health state utility and valuation of cosmetic rhinoplasty. Design, Setting, Participants: This is a cross-sectional survey administered through public online forums to 161 casual observers in America. Main Outcomes and Measures: Participants were shown pre- and postoperative photographs of six patients who underwent cosmetic rhinoplasty and two patients who did not undergo surgery. Observers were asked to imagine that the external nose in each image was on their own face and rated (1) their health state utility and (2) how much they were willing to pay (WTP) to have the ideal nose. Results: Established metrics of standard gamble and visual analog scale were explored in detail. Using these valuation and health utility data, we calculated WTP per quality-adjusted-life-year (WTP/QALY). The WTP/QALY for cosmetic rhinoplasty is $12,264 per QALY, which is significantly below cost-effective thresholds. Participants were willing to accept 10% risk of death to undergo cosmetic rhinoplasty. Conclusions and Relevance: Calculating WTP/QALY as a metric, we assess and quantify the social importance of rhinoplasty. This is the first study to demonstrate that elective cosmetic rhinoplasty can be a high-value intervention as perceived by society. Furthermore, the high percentage of risk of death that participants are willing to accept for cosmetic rhinoplasty suggests there is a profound psychosocial impact of external nasal deformity. These findings have implications for patients, surgeons, and health policy makers.

Prospective Qualitative Multidimensional Assessment of the Postoperative Rhinoplasty Experience.

Background: Understanding the multidimensional postoperative patient experience after rhinoplasty is critical for preoperative counseling and postoperative management. Methods: A prospective clinical study was conducted from June to December 2019 for 60 patients undergoing cosmetic and/or functional rhinoplasty by two facial plastic surgeons. All patients were administered the brief pain inventory, a clinically validated pain instrument, including multiple quality of life (QOL) domains, survey at postoperative days (PODs) 1, 2, 3, and 8. Nasal Obstruction Symptom Evaluation (NOSE) scores were used to predict patients having greatest QOL disturbance. Primary outcomes were postoperative QOL domains, pain scores, and oxycodone usage. Statistical analysis was performed using STATA 14.0 (STATA Corp., College Station, TX). Preoperative NOSE and postoperative Euro Quality of Life 5-Dimension scores were also recorded. Results: Patients showed greatest disruption to QOL in the first 3 PODs and essentially returned to normal levels by POD8, which mirrored trends in pain and opioid usage. All tested QOL domains (general activity, sleep, work, mood, enjoyment, and relationships) were strongly correlated with overall pain. NOSE scores were not significantly associated with pain or QOL impairment. Conclusions: This is the first study to prospectively evaluate the rhinoplasty patient's postoperative experience using a pain instrument, including multiple QOL domains. Utilizing a validated clinical instrument allows for standardized comparison of postrhinoplasty pain and QOL disruption with other surgical procedures and disease processes. These data may help guide preoperative counseling and set accurate patient expectations for the postoperative period.

Post-rhinoplasty outcomes in an Indian population assessed using the FACE-Q appraisal scales: a prospective observational study.

OBJECTIVES: The primary goal of rhinoplasty is patient satisfaction and improved quality of life. The present study was conducted to assess patient satisfaction with face and nose appearance, and quality of life after rhinoplasty. METHODS: Patients presenting for rhinoplasty completed the FACE-Q survey. This is a new instrument that measures patient-reported outcomes in those undergoing aesthetic procedures. The FACE-Q scales include satisfaction with facial appearance overall, satisfaction with the nose, psychological well-being, psychosocial distress and social function. RESULTS: Sixty-five patients completed the FACE-Q at pre-operative and at post-operative follow-up visits. Post-operative scores increased significantly in terms of: satisfaction with facial appearance (p < 0.0001, t = 15.639, degrees of freedom = 64); social function (p < 0.0001, t = 12.208, degrees of freedom = 64); psychosocial distress (p < 0.0001, t = 13.864, degrees of freedom = 64); psychological function (p < 0.0001, t = 12.681, degrees of freedom = 64); and satisfaction with nose (p < 0.0001, t = 16.421, degrees of freedom = 64). Most patients reported more than 79 per cent satisfaction with the post-operative outcome. CONCLUSION: The FACE-Q is an adequate instrument for determining successful aesthetic surgery based on patient satisfaction.

Male Rhinoplasty: Update.

Male rhinoplasty is unique in that it requires precise preoperative planning to achieve a successful result. Better communication and clarity are paramount with male rhinoplasty patients because the patients may be less attentive. It is important for the surgeon to screen the patients for any psychosocial disorders. Through a series of cases, male rhinoplasty techniques are highlighted. Masculine features should be preserved, and the nose should not be feminized or oversculpted. Another key component in any rhinoplasty case is proper skin care, especially during the postoperative period. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, V.

How You See Yourself: Cultural Considerations and Self-Image for Rhinoplasty Patients.

The motivations to pursue ethnically sensitive rhinoplasty and associated expectations are nuanced and influenced by the culture and institutional forces in a community. This article seeks to elucidate those nuances and the impact on self-image of patients seeking this procedure.