We read the article on the efficacy of rhinoplasty in facial rejuvenation by Karimi and Adelson with great interest. In the article, Karimi and Adelson concluded that rhinoplasty alone was not statistically rejuvenating the profile view of white women older than 55 years.

We would like to draw your attention to our recent publication entitled “Secondary cleft rhinoplasty rejuvenates the nose: a suggestion from a panel survey .” The primary purpose of our study was to evaluate a rejuvenating effect for the late cleft-lip nose deformity (CLND). The CLND nose shares some features in part with the aging nose, including tip ptosis, retracted columella, deformed nasal cartilaginous framework, increased nasal length, and convexity of the nasal dorsum . As with aging rhinoplasty, the aims of secondary cleft rhinoplasty are (1) to perform tip derotation and refinement; (2) to increase tip projection and columellar lengthening; (3) to decrease the overall nasal length and dorsal convexity; (4) to stabilize and support the internal nasal valves; and (5) to correct septal deviation and inferior turbinate hypertrophy, if present .

Using a cross-sectional study design, we enrolled a random sample of 51 health care providers who had regular contact with cleft patients and 507 laypersons; all were German. The panel was asked for the age estimates of noses in photographs derived from 8 German nonsyndromic CLND patients: 4 males and 4 females. All photographs were preoperative conditions of 6 patients, coupled with pre- and postoperative photographs of the other 2 patients. The most attractive female and male noses were also inquired. We reached the conclusions that (1) secondary cleft rhinoplasty rejuvenated the CLND nose and made it come close to the actual age of the patients and (2) the postoperative noses were the most attractive in both sexes . No difference between public and professional perceptions on nasal aesthetics was found, as demonstrated by other authors .

Now let us discuss why Karimi and Adelson’s findings and ours are so different. In our study, all photographs were black and white and displayed only frontal and lateral views of the nasolabial region of the subjects . Hence, the influence of the surrounding facial features, lighting, color, and contrast on the assessment is minimized . As suggested by Karimi and Adelson , their results may be skewed owing to color morphing and the aging jawline and neck because they used the lateral profile only. However, cropping the nasolabial area solely (as in our study) makes the presenting features differ greatly from the whole face in real life and in social interaction .

Our additional concern is related to the panel compositions. Karimi and Adelson did not describe the demographic data of their panel samples, except the age range. It is known that different sexes and different sexual orientations diverge the panel judgments on nasal aesthetics . Racial dissimilarity between evaluators and subjects may also influence the votes. The large sample size seems to have increased the external validity of our study.

Taken together, the different panel compositions and methods used hinder the comparison between Karimi and Adelson’s study and ours. As with the rejuvenating efficacy of secondary cleft rhinoplasty, we believe that although further investigations are still desirable, aging rhinoplasty helps other surgical procedures to rejuvenate the face in appropriately selected cases. The study by Karimi and Adelson should be interpreted with caution. Particular attention on the photograph preparation, the method used, and the panel composition and size would increase the generalizability of future research.