A prospective objective study of the cosmetic sequelae of nasal septal surgery

Following nasal septal surgery, minor aesthetic changes may occur in up to 39.5% of patients and major changes in up to 4.5%. As part of the informed consent procedure, the potential for cosmetic changes should be discussed with all patients undergoing nasal septal surgery.

To objectively measure aesthetic changes following nasal septal surgery using pre- and post-operative photographic documentation and to highlight issues surrounding informed consent for nasal septal surgery.

The study population comprised 75 patients undergoing nasal septal surgery (septoplasty, submucous resection or revision nasal septal surgery). The main outcome measures were measurement of aesthetic changes (tip projection, supra-tip depression and columella retraction) using standardized pre- and post-operative photographic documentation examined by two independent observers. Patients' subjective perception of a change in shape of their nose was assessed using a visual analogue scale. The presence of any septal perforations was recorded at the follow-up visit (mean 15 months, range 8-13 months, standard deviation 4.2 months).

The agreement between the two observers was very good when we considered a 1 mm difference as insignificant. Changes were arbitrarily defined as minor if < or =2 mm, and major, if > or =3 mm. With tip projection there was a minor change in 39.5% and major in 4.5% of patients. Supra-tip changes were minor in 6.7% and major in 1.3%. Minor columella changes occurred in 22% of patients, but there were no major changes. There was no statistically significant correlation between patients' subjective perception of changes in the shape of their nose with objectively measured changes. The septal perforation rate was 6.7%. Multivariate analyses (ANCOVA) showed no statistically significant influences of age, gender, grade of surgeon or type of nasal septal procedure.