Rhinoplasty outcome measurement

The literature includes few publications dealing with the measurement of rhinoplasty outcomes. We also lack reliable instruments for such measurements. In a population of 228 patients who underwent rhinoplasty performed by the same surgeon, we evaluated patient satisfaction using Alsarraf's questionnaire and an evaluation of cosmetic improvement using standardised pre- and post-operative photographs (Photograph Score from 1- great to 7- monstrous). We correlated these data with the severity of the pre-operative nasal deformities, (Predictable Difficulty Score) with the complexity of the surgical procedure, (Surgical Complexity Score) and with four specific surgical procedures (Spreader Grafting, Domal Interruption, Grafting of the Dorsum, Tip Grafting). Both Alsarraf's questionnaire and the photograph score identified a significant difference between the pre-operative and post-operative data and appear to be reliable instruments for measuring patient satisfaction. The questionnaire takes into account the functional outcome that the PS did not. In our hands, the mean improvement evaluated by the questionnaire was 50.2%, and 2.8 according to the PS, regardless of primary or revision surgery, traumatic or non-traumatic nose, mixed cosmetic/functional or purely cosmetic goals. The relative size of the difference between the pre- and post-operative scores was linked more to the satisfaction of the patient than to the absolute post-operative level. These two instruments (the questionnaire and the photograph score), although they are in agreement, did not allow for the establishment of any correlation between the satisfaction of the patient and the predicted difficulty score (PDS), the surgical complexity score (SCS), or three of the four specific procedures that were considered (SG, DI, GD and TG). Domal interruption was the only procedure in which we found that patient satisfaction was higher than with the other procedures (65.6% for the questionnaire and 3.8 for the photograph score).