Abstract
Objective
To determine how patients seeking cosmetic rhinoplasty analyze themselves compared to their surgeon’s analysis. Simply stated, “Does your surgeon view your nose the same as you?”
Study design
Prospective, blinded study.
Methods
All primary rhinoplasty consultations completed a nasal analysis questionnaire. The patients’ facial plastic surgeons completed an identical questionnaire. The results were compared and analyzed.
Results
Data underwent statistical analysis and subsequent factor analysis was performed. 132 patients participated in the study. Questions were grouped together based on factors: overall appearance, skin quality, tip dimensions, straightness, nostril show, and width. The only factor with reasonable surgeon/patient correlation was factor 1, overall appearance, with correlation 0.6473, p < 0.001.
Conclusions
Surgeons and patients are in agreement with the overall appearance of the nose, but differ in their analysis regarding the details. This information can be used to guide future discussions during consultations and most importantly help to better gauge and manage patient expectations.
1
Introduction
Successfully performing facial plastic procedures requires a thorough knowledge of facial anatomy, ideal facial proportions and appearances. Progressive improvement and refinement in this knowledge over time have led to numerous descriptions of anatomy, surgical techniques, and the use of alloplastic materials, etc. During the last 10 years, the literature describing different techniques for rhinoplasty alone has increased by a factor of ten. Despite increasing expertise in this area, however, true success is subjective, measured only by patient satisfaction postoperatively.
Numerous investigations have noted several factors that significantly influence patient satisfaction . Among them, patient expectations have been noted repeatedly to significantly affect patient satisfaction postoperatively. A thorough understanding, therefore, of patient expectations preoperatively is critical to obtaining a satisfied patient postoperatively. As described by R. Rohrich, plastic surgical procedures offer certain results that may not be clear to patients preoperatively . This, inevitably, may lead to patients’ dissatisfaction. Any steps surgeons can undertake to better assess patient expectations may lead to better postoperative patient satisfaction and, therefore, better outcomes.
Efforts to better understand how patients view themselves when considering facial cosmetic surgery may allow surgeons to set more accurate and realistic patient expectations. No studies to date have compared how the surgeons’ analysis compares with patient self-analysis in regards to rhinoplasty. This study, therefore, aims to determine how patients seeking cosmetic rhinoplasty analyze themselves compared to their surgeon’s analysis. Simply stated, “Does your surgeon view your nose the same as you?”
2
Methods
All first-time cosmetic, primary rhinoplasty consultations who presented to facial plastic surgery practices between November 1, 2009 and September 30, 2010 were asked to participate in the study. This included: Indiana University Health Physicians Facial Plastic Surgery (Indianapolis, IN; Shipchandler), The Johns Hopkins Center for Facial Plastic Surgery (Baltimore, MD; Shipchandler, Ishii, Boahene, Byrne), Facial Plastic Surgicenter (Pikesville, MD; Kontis, Papel), and Baltimore Center for Facial Plastic Surgery (Baltimore, MD; Capone). This study was approved by The Johns Hopkins University Institutional Review Board.
2.1
Rhinoplasty analysis questionnaire
With the input of all authors, a preoperative aesthetic nasal analysis questionnaire was developed consisting of 18 Yes/No questions ( Fig. 1 ). Questions addressed overall appearance of the nose such as: big vs. small, long vs. short, and large dorsal humps. Subsequent questions then focused on particular areas of the nose such as smaller dorsal humps, tip irregularities, nostril show, projection, rotation, and degree of straightness versus crookedness.
2.2
Patient assessment
All patients in the study were given a preoperative rhinoplasty analysis questionnaire. All questionnaires were answered by patients in the waiting or exam room before the patient spoke with the surgeon performing the examination and assessment. A mirror was given to all patients to aid them in completing the questionnaire.
In addition, all questionnaires asked the patient to complete specific optional demographic data: age, sex, ethnicity, reason for visit, and annual yearly income.
2.3
Physician assessment
Next, the surgeons participating in the study answered the identical 18 yes/no questions examining their patients’ nose in the exam room before obtaining preoperative photographs. Because patients rarely have the benefit of self-analyzing standardized rhinoplasty photographs, surgeons were not permitted to view photographs before completing the questionnaire.
2.4
Inclusion criteria
All first-time patients seeking primary rhinoplasty consultations were asked to join the study. Patients seeking rhinoplasty in addition to other treatments were also included in the study. One patient refused to participate for unknown reasons.
2.5
Exclusion criteria
Patients who had previously undergone cosmetic rhinoplasty surgery or had received a rhinoplasty consultation from another physician in the past were excluded. The authors felt that patients who had previously received consultations may be bias during their self-analysis toward what a previous physician had told them versus what they believe themselves. In addition, patients who had experienced nasal trauma with a resulting external nasal deformity within the previous 3 months were excluded from the study.
2.6
Data entry and coding
Data entry and analysis were performed in a blinded fashion by personnel not involved with obtaining any of the data or performing any of the analysis. All “Yes” answers were coded as “1” and all “No” answers were coded as “2”. All data was entered into Microsoft Excel spreadsheet and cleaned (Microsoft Inc., Redmond, WA).
2.7
Statistical analysis
Data were maintained in an Excel spreadsheet and exported to Stata SE 11.1 (Stata Corp., College Station, TX) for analysis. A factor analysis was performed on questions 1–3, 6–12, and 14–18. Questions 4 and 5 underwent a separate factor analysis, while question 13 was dropped due to data collection inconsistencies. A matrix of tetrachoric correlations was performed because the variables were binary. Component factor analysis was performed on the matrix to summarize most of the original information from the original set of variables in a minimum number of factors containing small proportions of unique variance. Component factor analysis was selected because the goal was data reduction.
The decision regarding the number of factors to extract was made using a scree plot of eigenvalues, whereby four factors were extracted. Orthogonal rotation was performed after factor selection in keeping with the goal of reducing the data to a smaller number of variables for subsequent use in other multivariate techniques.
2
Methods
All first-time cosmetic, primary rhinoplasty consultations who presented to facial plastic surgery practices between November 1, 2009 and September 30, 2010 were asked to participate in the study. This included: Indiana University Health Physicians Facial Plastic Surgery (Indianapolis, IN; Shipchandler), The Johns Hopkins Center for Facial Plastic Surgery (Baltimore, MD; Shipchandler, Ishii, Boahene, Byrne), Facial Plastic Surgicenter (Pikesville, MD; Kontis, Papel), and Baltimore Center for Facial Plastic Surgery (Baltimore, MD; Capone). This study was approved by The Johns Hopkins University Institutional Review Board.
2.1
Rhinoplasty analysis questionnaire
With the input of all authors, a preoperative aesthetic nasal analysis questionnaire was developed consisting of 18 Yes/No questions ( Fig. 1 ). Questions addressed overall appearance of the nose such as: big vs. small, long vs. short, and large dorsal humps. Subsequent questions then focused on particular areas of the nose such as smaller dorsal humps, tip irregularities, nostril show, projection, rotation, and degree of straightness versus crookedness.
2.2
Patient assessment
All patients in the study were given a preoperative rhinoplasty analysis questionnaire. All questionnaires were answered by patients in the waiting or exam room before the patient spoke with the surgeon performing the examination and assessment. A mirror was given to all patients to aid them in completing the questionnaire.
In addition, all questionnaires asked the patient to complete specific optional demographic data: age, sex, ethnicity, reason for visit, and annual yearly income.
2.3
Physician assessment
Next, the surgeons participating in the study answered the identical 18 yes/no questions examining their patients’ nose in the exam room before obtaining preoperative photographs. Because patients rarely have the benefit of self-analyzing standardized rhinoplasty photographs, surgeons were not permitted to view photographs before completing the questionnaire.
2.4
Inclusion criteria
All first-time patients seeking primary rhinoplasty consultations were asked to join the study. Patients seeking rhinoplasty in addition to other treatments were also included in the study. One patient refused to participate for unknown reasons.
2.5
Exclusion criteria
Patients who had previously undergone cosmetic rhinoplasty surgery or had received a rhinoplasty consultation from another physician in the past were excluded. The authors felt that patients who had previously received consultations may be bias during their self-analysis toward what a previous physician had told them versus what they believe themselves. In addition, patients who had experienced nasal trauma with a resulting external nasal deformity within the previous 3 months were excluded from the study.
2.6
Data entry and coding
Data entry and analysis were performed in a blinded fashion by personnel not involved with obtaining any of the data or performing any of the analysis. All “Yes” answers were coded as “1” and all “No” answers were coded as “2”. All data was entered into Microsoft Excel spreadsheet and cleaned (Microsoft Inc., Redmond, WA).
2.7
Statistical analysis
Data were maintained in an Excel spreadsheet and exported to Stata SE 11.1 (Stata Corp., College Station, TX) for analysis. A factor analysis was performed on questions 1–3, 6–12, and 14–18. Questions 4 and 5 underwent a separate factor analysis, while question 13 was dropped due to data collection inconsistencies. A matrix of tetrachoric correlations was performed because the variables were binary. Component factor analysis was performed on the matrix to summarize most of the original information from the original set of variables in a minimum number of factors containing small proportions of unique variance. Component factor analysis was selected because the goal was data reduction.
The decision regarding the number of factors to extract was made using a scree plot of eigenvalues, whereby four factors were extracted. Orthogonal rotation was performed after factor selection in keeping with the goal of reducing the data to a smaller number of variables for subsequent use in other multivariate techniques.
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