Perception that rhinoplasty makes patients more attractive

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Participants in a web-based survey who viewed pictures of patients before and after rhinoplasty have rated patients after surgery as more attractive, successful and overall healthier.

Rhinoplasty is one of the most common facial plastic surgery procedures performed in the US but few studies have looked that the impact of rhinoplasty on social perceptions.

In the study by Dr Lisa E Ishii, of Johns Hopkins University, Baltimore, and her co-authors, 473 casual observers completed a survey that included images of 13 unique patients before and after surgery, although survey participants were unaware of patients’ surgery status. No more than one photograph of the same patient was used.

Most of the survey participants were white, women and had four-year college degrees.

Survey results showed patients after rhinoplasty had higher average attractiveness scores, higher average perceived success scores and higher average perceived overall health scores, according to the study.

Limitations of the study include that the results do not reflect the spectrum of rhinoplasty surgical outcomes because the images used represented only optimal rhinoplasty outcomes. The study also does not reflect patients’ self-perceived change.

“These findings propose that patients experience an improvement in social interactions stemming from the positive effect of rhinoplasty surgery on observer perceptions. Furthermore, these results may improve physician-patient discussions about rhinoplasty surgery by providing a reference for an optimal outcome. However, variability in surgical outcomes must be considered when establishing surgical expectations and considering the effect on social perceptions,” the article concludes.

Abstract
Importance: To date, the impact of rhinoplasty surgery on social perceptions has not been quantified.
Objective: To measure the association of rhinoplasty with observer-graded perceived attractiveness, success, and overall health.
Design, Setting, and Participants: In a web-based survey, blinded casual observers viewed independent images of 13 unique patient faces before or after rhinoplasty. Delphi method was used to select standardized patient images, confirming appropriate patient candidacy and overall surgical effect. Observers rated the attractiveness, perceived success, and perceived overall health for each patient image. Facial perception questions were answered on a visual analog scale from 0 to 100, where higher scores corresponded to more positive responses. A multivariate mixed-effects regression model was used to determine the effect of rhinoplasty while accounting for observer biases. To further characterize the effect of rhinoplasty, estimated ordinal rank change was calculated for each domain.
Main Outcomes and Measures: The primary objective was to measure the effect of rhinoplasty on observer-graded perceived attractiveness, success, and overall health.
Results: A total of 473 observers (mean age, 29 years [range, 18-73 years]; 305 [70.8%] were female) successfully completed the survey. On multivariate regression, patients after rhinoplasty were rated as significantly more attractive (rhinoplasty effect, 6.26; 95% CI, 5.10-7.41), more successful (rhinoplasty effect, 3.24; 95% CI, 2.32-4.17), and overall healthier (rhinoplasty effect, 3.78; 95% CI, 2.79-4.81). The ordinal rank change for an average individual’s perceived attractiveness, success, and overall health was a positive shift of 14, 9, and 10 out of 100 rank positions, respectively.
Conclusions and Relevance: As perceived by casual observers, rhinoplasty surgery was associated with perceptions that in patients appeared significantly more attractive, more successful, and healthier. These results suggest patients undergoing rhinoplasty may derive a multifaceted benefit when partaking in social interactions. Furthermore, these results facilitate improved patient discussions aiming to provide more precise surgical expectations with an understanding that these results represent optimal outcomes.

Authors
Jason C Nellis, Masaru Ishii, Kristin L Bater, Ira D Papel, Theda C Kontis, Patrick J Byrne, Kofi DO Boahene, Lisa E Ishii

JAMA material
JAMA Facial Plastic Surgery abstract
Invited Commentary


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