Rhinoplasty remains a consistently popular aesthetic facial procedure because it fundamentally works and is capable of making significant facial appearance improvements. While it is not a perfect operation and it has its own risk of the need for revision procedures, it is associated with high patient satisfaction scores. The interesting question is what changes of the nose are perceived as most significant to others. We know that the most important changes are what the patient perceives and that is how rhinoplasty surgery is done with those desired changes in mind.
In the June 2018 issue of JAMA Facial Plastic Surgery, an article was published entitled ‘Association of Dorsal Reduction and Tip Rotation With Social Perception’. Based on a web-based survey was done to try and answer the basic question of what are the differences in social perception of people who undergo rhinoplasty for dorsal hump reduction, tip rotation, or both? In other words which nasal change was seen by others as more significant…reduction of a prominent bridge or changing the shape of the top of the nose. The survey was done using blinded evaluations of preoperative images of four patients who had computer simulations of various combinations of dorsal hump reduction and tip rotation. The survey asked to estimated the age, approachability, perceived success, health, intelligence, and attractiveness on a visual analog scale from 0 to 100.
Their findings showed that a significant age reduction and an increase in approachability, attractiveness and health seen for the computer simulation involving hump reduction. The simulation for dorsal reduction and tip rotation showed increases only for attractiveness and health. The simulation for tip rotation only showed no changes in any of the evaluated measures.In short, a significant association was found for age, approachability, attractiveness, and health for hump reduction and attractiveness and health for combined dorsum and tip rotation changes. No significant association was found for tip rotation alone.
While rhinoplasty surgery is capable making many changes to the nose, the biggest surface area of change is along the length of the osteocartilaginous dorsum. As the major contributor to the profile of the nose in side and oblique facial views, changing the dorsal height is extremely observable to others. For many patients a prominent nasal hump and its reduction is often one of the most important changes they request and is one of the most common and basic elements of many rhinoplasty surgeries. It has long been known that a dorsal hump is associated with a negative social perception and that its reduction does make the face more pleasing.
It is interesting in this study that what happens to the nasal tip is less perceived to others than it is to the patient. That, of course, would depend on what the original nasal deformity is. In the presence of a straight dorsum with certain nasal tip deformities the public perception of its change may be more significantly perceived.
Dr. Barry Eppley
Indianapolis Indiana