Outcomes, satisfaction and the patient

Rhinoplasty is measured with ten different questionnaires, none of which covers both the way the nose looks and the way it breathes, and the best-developed one has no airway questions at all. Most published results therefore describe half the operation. What patients report is consistent anyway: large gains in appearance and in psychological well-being, smaller gains in breathing satisfaction than in breathing itself, and a dissatisfied minority whose distress was measurable before the operation rather than caused by it.

233papers on file 35this page is written from 9journals, 2011–2026 58open access, full text 175with a plain-language summary

Where these 233 papers were published

59Aesthetic Plastic SurgeryAesthetic Plast Surg
49Plastic and Reconstructive SurgeryPlast Reconstr Surg
44Facial Plastic SurgeryFacial Plast Surg
30Facial Plastic Surgery and Aesthetic MedicineFacial Plast Surg Aesthet Med
21Aesthetic Surgery JournalAesthet Surg J
13JAMA Facial Plastic SurgeryJAMA Facial Plast Surg
12Plastic and Reconstructive Surgery Global OpenPlast Reconstr Surg Glob Open
4Facial Plastic Surgery Clinics of North AmericaFacial Plast Surg Clin North Am
1Archives of Facial Plastic SurgeryArch Facial Plast Surg

42011 52012 42013 62014 62015 72016 62017 132018 122019 172020 192021 202022 192023 352024 262025 342026

56 further papers on this topic came in through the history rather than the archive query: 1970, Rogers BO 1986, Roe JO 1989, Tardy ME Jr 1993 and 52 more. They are counted on the landmark papers, not here.

What repeats

Six findings reported by independent groups in different countries. Each card carries the papers it rests on.

The field measures itself with ten instruments and no standard

Twelve randomised trials and 743 patients, systematically reviewed: ten distinct patient-reported outcome measures in use, mean follow-up 9.1 months. FACE-Q is the most rigorously developed, meeting 19 of 21 development standards, and it does not measure the airway at all. There is still no validated instrument covering both halves of the operation. Two of the commonest scales, NOSE and the SCHNOS obstruction subscale, are on different metrics, and 552 patients had to complete both so their scores could be linked by Rasch analysis before results from different practices could be compared.

Rests on: Khajuria et al., systematic review of randomised trials · van Zijl et al., linking NOSE and SCHNOS.

Satisfaction is high, and it is not the same thing as a good nose

Pooling eight observational studies, satisfaction rose substantially after cosmetic-functional rhinoplasty, most in younger patients and most at six to twelve months. In 234 patients asked directly, psychological satisfaction (70.9%) exceeded both cosmetic (63.2%) and functional satisfaction (59%). But satisfaction is measured against expectation, not against anatomy: preoperative aesthetic expectation averaged 89.69 on a 100-point scale while satisfaction with the actual result sat between 72 and 79 at every interval past a year. And now there is a baseline: in 1,134 Dutch adults who never sought surgery, satisfaction with one's own nose is high, rises with age, and is lower among people with a non-Western background.

Rests on: Yang et al., meta-analysis of satisfaction and quality of life · Omer et al., 234 patients · Kandathil et al., expectation against satisfaction · Kasapov et al., population normative data.

About one in three candidates screens positive for body dysmorphic disorder

Thirty-three per cent with at least moderate symptoms in the first large study of 226 candidates; 35.1% against 3.2% in controls in a Brazilian comparison; a pooled 30.0% across fifteen studies and 1,977 Asian candidates, with the figure moving from 36% to 18% depending on whether a questionnaire or DSM-5 criteria were used. The clinical finding underneath is the one that matters: independent observers' scoring of the nose and the patient's own scoring of it did not correlate at all. What the person is distressed about is not measurable on their face. The whole of this, written for people rather than as statistics, is on the psychology of rhinoplasty.

Rests on: Picavet et al., 226 candidates · de Souza et al., candidates against controls · Chua et al., pooled prevalence.

What the patient brings in predicts the result better than what the surgeon does

Following 166 patients for a year, preoperative dysmorphic symptom scores ran inversely against satisfaction at three months and twelve. Screen-positive patients were less satisfied with appearance and carried five-fold odds of severe aesthetic concern afterwards. A single questionnaire item, decreased mood and self-esteem because of my nose, separated a 16.7% to 18.8% revision rate from 0%. Patients with a psychiatric diagnosis returned for a further operation at 18% against 12%. And patients who brought malpractice claims scored lower on body-image quality of life and self-esteem and higher on somatization than patients who did not.

Rests on: Picavet et al., one-year prospective · Moosaie et al., screen-positive against negative · Okland et al., nasal self-esteem predicts revision · Tie et al., psychiatric diagnoses · Oduncu et al., predictors of malpractice claims.

Screening flags distress; it does not predict who benefits

In 115 patients screened before and after surgery, 83% of positive body-dysmorphia screens resolved afterwards, and resolution tracked with better aesthetic satisfaction, but nothing measured beforehand predicted which patients would resolve. Mental health does not block a functional result either: 88 patients with cosmetic and functional goals improved on airflow measures and their own breathing scores regardless of whether their mental well-being scored as impaired. Selection currently rests on judgement, and the published pathways put a psychologist inside it rather than at the end of it.

Rests on: Losorelli et al., screening resolution · Strazdins et al., mental health and functional outcomes · Auer et al., surgeon and psychologist.

Technique differences shrink when patients are the ones scoring

Preservation against structural rhinoplasty: significant for preservation across four randomised trials, gone by twelve months in a seven-year cohort, absent altogether in the largest functional meta-analysis. Spreader graft against spreader flap: no difference. Open against closed: no difference across 1,067 patients. Raters shown before-and-after photographs identify the approach at chance. What does move patient-reported scores by large margins is fixing an airway, correcting a cleft nose at maturity, and matching the operation to the patient's own stated goal.

Rests on: Shim et al., four randomised trials · Wei et al., seven-year cohort · Chan et al., functional meta-analysis · McCleary et al., raters at chance · Zhao et al., functional rhinoplasty pooled · Hashemipour and Danesh, anatomy-led planning.

By measure

What each instrument actually measures, and what it has shown.

FACE-Q

The most rigorously developed appearance instrument: satisfaction with the nose, with facial appearance overall, psychological well-being and social function, scored separately. In 56 rhinoplasty patients it moved facial-appearance satisfaction 26.5 points, psychological well-being 15.7 and social function 13.7. It does not ask about breathing.

Key papers: Khajuria et al. · Schwitzer et al., FACE-Q before and after · Schwitzer et al., demographic differences in gain.

SCHNOS

The one instrument built for rhinoplasty specifically, with an obstruction subscale and a cosmesis subscale. Its fifth item, mood and self-esteem because of the nose, is the single question that predicted revision. It is now linked to NOSE by validated crosswalk tables.

Key papers: Okland et al. · van Zijl et al..

NOSE

Five questions about breathing, scored 0–100, and the most-used functional measure in this field. Pooled across 43 studies and 2,024 patients, functional rhinoplasty moved it by 43 to 48 points and held to a year.

Key papers: Zhao et al. · Chen and Zhou, functional rhinoplasty and quality of life.

ROE

Six questions on how the patient rates their nose and how they think others see it. Short, widely used, and the reason many series can report satisfaction at all, including the non-surgical and secondary-filler series.

Key papers: Yang et al. · Valente and Zanella, 1,122 secondary filler cases.

The expectation instruments

Expectation is the number satisfaction is measured against, so it can be measured before the operation: the Expectations of Aesthetic Rhinoplasty Scale, validated in Turkish, and a four-component questionnaire capturing the four motives behind a functional request.

Key papers: Yeniceri et al., EARS validation · Spiekermann et al., the four-component questionnaire.

The psychological instruments

BDDQ and its aesthetic-surgery version for screening, the modified Yale-Brown scale for severity, the Body Dysmorphic Symptoms Scale for use by a surgeon rather than a psychiatrist, and, new in 2026, MEADS-25 for the distress patients feel when the cast comes off and they see the face for the first time.

Key papers: Chua et al. · Losorelli et al. · Abbas, mirror-confrontation distress.

Observers, crowds and machines

Because patient scores are subjective, three other rater types are now used: blinded surgeon panels, crowdworkers on rating platforms, and automated photograph analysis. All three converge on the same conclusion in the preservation comparison, improvement in both arms, and no ability to tell which operation was done.

Key papers: Alford et al., crowdsourced assessment · McCleary et al. · Skochdopole et al., how tip-graft studies report outcomes.

Long-term outcomes, where they exist

Almost nothing follows patients past two years. The exceptions are in cleft care: 342 patients over eighteen years of intermediate cleft rhinoplasty, where an iliac crest graft predicted fewer subsequent operations; and five-year FACE-Q follow-up after the Tajima technique in 96 patients, with satisfaction gains holding.

Key papers: Ng et al., eighteen years of intermediate cleft rhinoplasty · Liu et al., five-year follow-up.

The terms, defined

Every term the papers above use to mean something specific, in plain language.

Patient-reported outcome measure (PROM): a validated questionnaire the patient fills in, rather than the surgeon's opinion of the result. Ten are in use in rhinoplasty; none covers both appearance and breathing. [41071223]
FACE-Q: modular appearance and well-being scales, the most rigorously developed instrument here, with no airway questions. [41071223, 25919265]
SCHNOS: the Standardized Cosmesis and Health Nasal Outcomes Survey, with separate obstruction and cosmesis subscales; the closest thing to a rhinoplasty-specific instrument. [32856710]
NOSE: the Nasal Obstruction Symptom Evaluation, five items scored 0–100, breathing only. [35099579]
ROE: the Rhinoplasty Outcome Evaluation, six items on appearance and perceived social response. [29135891]
SNOT-22: a 22-item sinonasal symptom score, broader than the nose. [37173413]
EARS and the 4CQ: instruments that measure what the patient expects, and why they came, before the operation. [39447621, 30041266]
BDDQ, BDD-YBOCS, BDSS: body dysmorphic disorder screening and severity instruments; the first two flag, the third is designed for a surgeon to administer. [40907540, 38452148]
MEADS-25: the Mirror-Confrontation and Early Adaptation Distress Scale, measuring distress at the first sight of the postoperative face. [42424527]
Rasch analysis and crosswalks: the statistical method that puts two different questionnaires on one scale so their scores can be translated. [38551458]
Minimal clinically important difference (MCID): the smallest score change a patient would notice; the threshold that separates a statistically significant result from a meaningful one. [41369038]
Normative data: what the general population scores on the same instrument. Without it, "improved to 80" means nothing. [42670247]
Standardised mean difference (SMD): how meta-analyses combine studies that used different questionnaires: roughly 0.2 small, 0.5 moderate, 0.8 large. [40906288, 42314704]
Crowdsourced rating: untrained members of the public scoring before-and-after photographs on a platform, used as an independent aesthetic measure. [39498873]

The papers this rests on

The 35 papers everything above was written from. Every one links to its abstract, its authors and its DOI.

PRS
A Systematic Review of Randomized Control Trials on Patient-Reported Outcome Measures in Rhinoplasty
Khajuria A, Rupra RS, Daneshi K et al.

2025PMID 41071223Summary
PRS
The Rhinoplasty Rosetta Stone: Using Rasch Analysis to Create and Validate Crosswalks between the NOSE and the SCHNOS Functional Subscale
van Zijl FVWJ, Declau F, Rizopoulos D et al.

2024PMID 38551458Summary
ASJ
Establishing Normative Data on Satisfaction with Nasal Appearance: a Dutch Population-Based Study Using Aesthetic Rhinoplasty Outcome Instruments
Kasapov M, Afonso PM, Datema FR et al.

2026PMID 42670247Summary
PRS
Evaluation of Preoperative and Postoperative Patient Satisfaction and Quality of Life in Patients Undergoing Rhinoplasty: A Systematic Review and Meta-Analysis
Yang F, Liu Y, Xiao H et al.

2018PMID 29135891Summary
APS
The Effect of Functional Rhinoplasty on Quality of Life: A Systematic Review and Meta-Analysis
Chen K, Zhou L

2024PMID 37173413Summary
PRS
Assessing Patient-Reported Satisfaction with Appearance and Quality of Life following Rhinoplasty Using the FACE-Q Appraisal Scales
Schwitzer JA, Sher SR, Fan KL et al.

2015PMID 25919265Summary
ASJ
Assessing Demographic Differences in Patient-Perceived Improvement in Facial Appearance and Quality of Life Following Rhinoplasty
Schwitzer JA, Albino FP, Mathis RK et al.

2015PMID 26063837Summary
FPSAM
Examining Preoperative Expectations and Postoperative Satisfaction in Rhinoplasty Patients: A Single-Center Study
Kandathil CK, Patel PN, Spataro EA et al.

2021PMID 33337943Summary
FPS
Turkish Translation and Validation of the Expectations of Aesthetic Rhinoplasty Scale
Yeniceri A, Yasar NG, Hazır B et al.

2025PMID 39447621Summary
FPS
The Mirror of Culture: A Systematic Review and Meta-Analysis of the Prevalence of Body Dysmorphic Disorder in Asian Rhinoplasty Seekers
Chua NYM, Gao EZ, Loh SBJ et al.

2026PMID 40907540Summary
PRS
High prevalence of body dysmorphic disorder symptoms in patients seeking rhinoplasty
Picavet VA, Prokopakis EP, Gabriëls L et al.

2011PMID 21788842Summary
PRS
Preoperative symptoms of body dysmorphic disorder determine postoperative satisfaction and quality of life in aesthetic rhinoplasty
Picavet VA, Gabriëls L, Grietens J et al.

2013PMID 23249985Summary
APS
Body Dysmorphic Disorder in Rhinoplasty Candidates: Prevalence and Functional Correlations
de Souza TSC, Patrial MTCRO, Meneguetti AFC et al.

2021PMID 32875438Summary
ASJ
Rhinoplasty Outcomes in Patients With Symptoms of Body Dysmorphia
Losorelli S, Kimura KS, Wei EX et al.

2024PMID 38452148Summary
APS
Comparison of Aesthetic and Functional Rhinoplasty Outcomes Between Patients with Body Dysmorphic Disorder and Normal Individuals
Moosaie F, Javankiani S, Mansournia MA et al.

2024PMID 38575764Summary
ASJ
Psychological Red Flags in Rhinoplasty: Predictors of Malpractice Claims
Oduncu M, Çelik M, Boylu ME et al.

2026PMID 41419223Summary
JAMA FPS
Association Between Mental Health Status and Patient Satisfaction With the Functional Outcomes of Rhinoplasty
Strazdins E, Nie YF, Ramli R et al.

2018PMID 29450446Summary
ASJ
Mirror-Confrontation Distress After Rhinoplasty: Development and Validation of a Patient-Reported Outcome Measure
Abbas OL

2026PMID 42424527Summary
FPS
A Multidisciplinary Approach to Rhinoplasty: The Facial Plastic Surgeon and the Psychologist
Auer D, Saroha S, Unadkat SN et al.

2026PMID 41248892Summary
APS
Ethnic Considerations in Rhinoplasty: A Meta-Analysis of Outcomes and Complications in Caucasian Versus Non-Caucasian Patients
Hashemipour Y, Danesh HA

2026PMID 40906288Summary
APS
Ethnic Variations and Surgical Outcomes in Rhinoplasty: A Systematic Review
Reid D, Sejour PM, Kahlon S et al.

2025PMID 40494973Summary
PRS
Dorsal Preservation versus Conventional Hump Reduction Rhinoplasty: A Seven-Year Review of Patient Reported Outcomes and Concurrent Operative Techniques
Wei EX, Fu B, Huang H et al.

2026PMID 42053436Summary
APS
Comparison of Patient-Reported Outcomes Between Dorsal Preservation and Conventional Dorsal Hump Reduction Rhinoplasty: A Systematic Review and Meta-Analysis
Kim DH, Jang DW, Hwang SH

2025PMID 40195129Summary
ASJ
Crowdsourced Assessment of Aesthetic Outcomes of Dorsal Preservation Rhinoplasty
Alford JA, McCleary S, Roostaeian J

2025PMID 39498873Summary
PRS
Dorsal Preservation versus Open Structural Rhinoplasty: Can We Tell the Difference between Aesthetic and Functional Outcomes?
McCleary S, Khan A, Khetpal S et al.

2025PMID 40331571Summary
FPS
Functional Outcomes of Dorsal Preservation Rhinoplasty: A Systematic Review and Meta-analysis
Chan C, North AS, Khademi Mansour HR et al.

2026PMID 42532128Summary
ASJ
Comparison of Functional and Cosmetic Outcomes Between Dorsal Preservation and Spreader Flap Rhinoplasty: A Randomized Trial
Zarei R, Most SP, Amali A et al.

2024PMID 38366551Summary
PRS
Current Surgical Outcomes of Nasal Tip Grafts in Rhinoplasty: A Systematic Review
Skochdopole AJ, Bay CC, Grome L et al.

2023PMID 36723630Summary
FPSAM
Variation in Practice Patterns of Current Rhinoplasty Surgeons for Nasal Valve Compromise
Harounian JA, Yu D, Lu X et al.

2024PMID 34495760Summary
PRS-GO
Functional, Cosmetic, and Psychological Outcomes after Rhinoplasty
Omer G, Girolamo S, Hamatofiq B et al.

2024PMID 39157708Summary
ASJ
Secondary Liquid Rhinoplasty: Challenges, Techniques, and Long-term Outcomes
Valente DS, Zanella RK

2026PMID 41124352Summary
PRS
Long-Term Outcome of Secondary Cleft Rhinoplasty in Patients with Secondary Nasal Deformity: Optimal Indications for Tajima Technique
Liu Y, Zhang C, Yao M et al.

2025PMID 38967637Summary
PRS
Long-Term Surgical Outcomes of Intermediate Cleft Rhinoplasty
Ng JJ, Cheung L, Massenburg BB et al.

2025PMID 39560597Summary
APS
Rhinoplasty as a medicalized phenomenon: a 25-center survey on quality of life before and after cosmetic rhinoplasty
Mohammadshahi M, Pourreza A, Orojlo PH et al.

2014PMID 24902906Summary
APS
A Comparative Analysis of Patients' Quality of Life, Body Image and Self-confidence Before and After Aesthetic Rhinoplasty Surgery
Borujeni LA, Pourmotabed S, Abdoli Z et al.

2020PMID 31832733Summary

What is still contested

There is no validated rhinoplasty PROM covering appearance and airway together, and the best appearance instrument ignores breathing entirely. Every result in this field is therefore partial. [41071223]
Mean follow-up in the randomised literature is 9.1 months. The nose is still changing at twelve months and the revision decision is usually made after that. [41071223]
Satisfaction runs 85–99% almost everywhere it is measured, which is more likely to reflect who answers the questionnaire than how good the operations are. Non-responders are almost never characterised.
Whether surgery helps people with dysmorphic symptoms is unresolved: 83% of positive screens resolved in one cohort, while preoperative symptoms predicted dissatisfaction in another. Neither randomised anyone. [38452148, 23249985]
Nothing measured before surgery predicts which screen-positive patient will do well. [38452148]
Quality of life improved in most series and fell in one 25-centre survey where motivation was mainly external. That study is the only one on file where the answer is negative, and it is also the only one from that health system. [24902906, 31832733]
Benefit is unevenly distributed in the one cohort that looked: women, Caucasian patients, patients under 35 and patients on higher incomes showed the significant gains. [26063837]
Surgeons disagree with their own consensus statement about which diagnostic measures are needed at all. [34495760]