Assessing the rhinoplasty outcome: inter-rater variability of aesthetic perception in the light of objective facial analysis

The aim of this study was to assess the success of rhinoplasty by evaluating the inter-rater variability in the light of primary indication as functional or cosmetic. Subjective aesthetic perception was compared with objective facial analysis. 45 rhinoplasty patients were included in the study. 25 had cosmetic plus functional reasons with septal deviation (group 1) and 20 had pure cosmetic reasons without septal deviation (group 2). Preoperatively and 6 months postoperatively, four individuals (patient, surgeon, 2 independent surgeons) rated the aesthetic appearance of the nose with visual analogue scale. Facial photogrammetric analysis was applied. The patient’s aesthetic perception score was significantly correlated with the two independent surgeons (p < 0.05) whereas not with the primary surgeons. Regarding the objective parameters, patient’s aesthetic perception was significantly correlated with the dorsal alignment in both groups (p < 0.05). General satisfaction score was significantly correlated with the nasal breathing as well as with the aesthetic perception scores in both groups. This correlation was higher for aesthetic perception in group 1 and nasal breathing in group 2. Inter-rater variability of outcome perception was higher in cosmetic patients. Nasal dorsal alignment was the only objective parameter which was correlated with the patient’s perception. Patient’s perception of outcome has better represented the objective photogrammetric analysis rather than the primary surgeons. An interesting finding was the more significant correlation of general satisfaction with aesthetic perception in the functional group whereas nasal breathing in the cosmetic group.