Examining Preoperative Expectations and Postoperative Satisfaction in Rhinoplasty Patients: A Single-Center Study

Bridging the Gap: Understanding Appalachian Patient Satisfaction in Cosmetic Rhinoplasty

Rhinoplasty is a surgical procedure aimed at correcting both functional and aesthetic nasal deformities, addressing issues such as trauma-induced disfigurements and patient dissatisfaction with nasal appearance. Patient satisfaction is a critical outcome measure in rhinoplasty, reflecting the success of the procedure and the quality of care provided. This study investigates factors influencing patient satisfaction among Appalachian patients undergoing rhinoplasty for aesthetic reasons, considering the unique healthcare challenges faced by rural populations. A modified Rhinoplasty Outcome Evaluation questionnaire was utilized to assess patient satisfaction. Descriptive statistics and regression analyses were performed to analyze demographic characteristics, complications, re-operations, and satisfaction scores among rural and urban participants. While no significant differences were found in demographic characteristics, trends in satisfaction scores suggest potential disparities between rural and urban populations. Rural patients exhibited marginally lower satisfaction scores and higher rates of complications and re-operations, highlighting the need for targeted interventions in rural healthcare settings. Addressing geographic barriers, enhancing preoperative education and postoperative support, and fostering interdisciplinary collaboration are essential strategies to improve patient satisfaction and outcomes in rhinoplasty procedures, particularly in rural communities. Further research with larger sample sizes and qualitative methods is warranted to explore the underlying factors contributing to patient satisfaction disparities and to inform evidence-based interventions aimed at narrowing healthcare disparities and advancing health equity in rhinoplasty care.

Outcomes of Diced Cartilage Dorsal Augmentation in Dorsal Aesthetic Deformities

Objective: To investigate the effectiveness of diced cartilage graft for dorsal augmentation in rhinoplasty. Methods: In a retrospective study, patients who underwent rhinoplasty with dorsal augmentation using diced cartilage graft from June 2017 to December 2021 were identified. Patients with complete preoperative and at least one postoperative Standardized Cosmesis and Health Nasal Outcomes Survey-Cosmesis (SCHNOS-C) and visual analogue scale (VAS) scores were included in the study. Postoperative periods were classified into ≤6 and >6 months. Mean preoperative outcome scores were compared with postoperative scores utilizing a Paired t-test, and postoperative scores were compared utilizing a Wilcoxon rank-sum test. Results: A total of 71 patients with a median age of 36 years, range (18-74) fit inclusion criteria. Majority were female patients 49 (69%). The postoperative period ranged from 17 days to 3.5 years. The mean follow-up period (standard deviation) for ≤6 and >6 months was 2.8 (1.5) and 14.2 (6.3) months, respectively. A decrease in mean SCHNOS-C, SCHNOS item 8, and an increase in VAS scores (p < 0.0001) were seen at both postoperative time periods compared with preoperative levels. Conclusion: This study demonstrates that dorsal augmentation with diced cartilage graft is an effective technique in correcting dorsal aesthetic deformities.

Discrepancy of the subjective perception of the nasal appearance between independent individuals and patients undergoing functional rhinoplasty (fRPL)

PURPOSE

Satisfaction with the nasal appearance is a crucial outcome parameter in functional rhinoplasty (fRPL). The visual analogue scale is a suitable instrument not only for the preoperative patient assessment, but also as a patient-reported outcome measure in fRPL. In this study, we analyzed whether a high discrepancy in the preoperative subjective perception of the nasal appearance between patients and other individuals predicts a lower level of satisfaction with the postoperative result and hence a worse outcome of fRPL.

METHODS

Standardized facial pictures of patients (n = 80) who underwent fRPL were taken preoperatively, 3 and 12 months postoperatively. In addition, patients were asked to complete the German version of the Utrecht Outcome Assessment Questionnaire in Aesthetic Rhinoplasty (D-OAR). The standardized facial pictures of the patients were presented to surgeons as well as to examiners without a medical background, and they were asked to evaluate the patients' nasal appearance using the visual analogue scale.

RESULTS

The external evaluation of patient's nasal appearance was 1.7 points higher in median than the patient's subjective perception (range -5.7-7.00). A large discrepancy between self- and external estimation significantly correlates with higher D-OAR values (r = 0.539, p < 0.001). Patients with high scores in the D-OAR trick questions, indicating a body dysmorphic disorder, show a significant larger discrepancy between the external- and the self-assessment (2.8 ± 0.5 vs. 1.4 ± 0.3, mean ± SEM, p = 0.017).

CONCLUSIONS

Large discrepancies between the self and external assessment of the nasal appearance are associated with a high-perceived influence of the appearance of the nose on the quality of life in patients undergoing functional rhinoplasty. That might be an indicator for unrealistic expectations concerning the postoperative outcome. Knowledge about this factor helps to identify the need for intensive discussion about possibilities and limitations of the planned procedure to avoid postoperative dissatisfaction.

Patient Recovery and Satisfaction with Perioperative Care After Rhinoplasty

Background: Recovery after rhinoplasty is not well characterized in the literature. Objective: To quantify key aspects of patient recovery after rhinoplasty and characterize factors that may impact recovery and overall satisfaction with perioperative care. Methods: Prospective cohort study of rhinoplasty patients undergoing surgery at a tertiary referral center between January 2018 and January 2020, and completed a patient experience questionnaire at first postoperative visit. Results: Fifty-one patients underwent functional septorhinoplasty. Mean age was 37.8 years (standard error [SE] 2.4) with median 36.0 years (range 16-79). Fifty-three percent were female (n = 27). Patients resumed most daily activities within 4.1 days. Overall satisfaction with perioperative care was high (mean 9.6, SE 0.1), although 29% of patients (n = 15) wished they had more information regarding surgical care. Patients who did not desire additional information reported higher satisfaction and faster time to activity recovery compared with those who desired additional information. Conclusions: Rhinoplasty patients are able to resume most routine activities within 4.1 days after surgery, although patients desiring additional information about care demonstrate lower satisfaction with perioperative care and slower recovery compared to those who felt well informed.

Comparison of the Distribution of Standardized Cosmesis and Health Nasal Outcomes Survey Scores Between Symptomatic and Asymptomatic Patients

Background: The Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) is a validated patient-reported outcome measure that evaluates subjective cosmetic and functional complaints. The goal of this study was to compare scores between patients with and without nasal complaints. Methods: This is a retrospective review of SCHNOS-O (obstructive) and SCHNOS-C (cosmetic) scores in patients presenting for functional or cosmetic concerns between 2019 and 2020. Receiver operating characteristic curve analysis was used to determine the score that best separated symptomatic from asymptomatic patients. SCHNOS scores were also subdivided to define severity of presenting complaints. Results: In total, 414 patients were included. A SCHNOS-O score of 40 differentiated patients with and without nasal obstruction. Patients may be categorized as having mild (<40), moderate (45-70), and severe (75-100) nasal obstruction based on the SCHNOS-O score. A score of 30 on the SCHNOS-C differentiated patients with and without aesthetic concerns. Patients may be categorized as having mild (<33.3), moderate (33.3-66.6), and severe (>66.6) aesthetic distress based on the SCHNOS-C. Conclusion: An understanding of SCHNOS scores that differentiate symptomatic for asymptomatic patients can aid in the preoperative evaluation of rhinoplasty patients.