Objective assessment of facial asymmetry in rhinoplasty patients

To determine the incidence and nature of facial asymmetry in patients referred for consideration of aesthetic rhinoplasty and to assess whether objective anthropometric facial measurements correlate with subjective perceptions of asymmetry.

Two independent observers measured facial features, including midline to medial and lateral canthi, tragus, ala, and oral commissure distances, in 234 prerhinoplasty surgical photographs. The photographs were rated by 10 independent observers for a global "first impression" of facial symmetry, and the relationship between anthropometric measurement and subjective perception of facial symmetry was explored with logistic regression.

Objectively, 97% of patients had significant degrees of facial asymmetry, with the midline to ala distances showing the most variations and the midline to oral commissures showing the least variations. Subjectively, 38% of results were perceived as asymmetrical, with the degree of midline to lateral alar margin asymmetry being an independent predictor of the perception of facial asymmetry on binary logistic regression (P<.003).

A significant correlation was found between the degree of objective facial asymmetry, particularly in anthropometric nasal measurements, and the subjective perception of a face as asymmetrical in patients requesting aesthetic rhinoplasty. This relationship may be a factor in patients who request rhinoplasty and should be explored in this patient group.