Nasal Aesthetic Preferences Across Populations: A Systematic Review of Cultural, Ethnic, and Generational Trends

Nasal aesthetics are central to rhinoplasty outcomes, yet ideals of beauty vary considerably across cultures, ethnicities, and generations. Current evidence is fragmented, often Eurocentric, and lacks a comprehensive synthesis. This systematic review aimed to evaluate nasal aesthetic preferences and their implications for clinical practice. The protocol was prospectively registered on PROSPERO (CRD420251009102). Systematic searches of PubMed, Embase, Web of Science, and PsycINFO were conducted from inception to June 2025. Eligible studies assessed nasal aesthetic preferences in adult (≥18 years) populations. The Newcastle-Ottawa Scale (NOS), NOS-xs, Grading of Recommendations, Assessment, Development and Evaluations, and Appraisal tool for Cross-Sectional Studies tools were used to guide critical appraisal, and findings were synthesized narratively. A total of 2881 records were screened, yielding 31 studies with 25,382 respondents. Preferences demonstrated marked regional variation: North American Caucasians favored a slight dorsal scoop with mild underprojection, whereas East Asian/Middle Eastern groups preferred a straight dorsum with more obtuse nasolabial angles. Chinese cohorts most frequently selected radix positions at the pupil, Japanese studies reported stable nasofacial angles of 30° to 33°, and Syrian findings converged around ∼31°. Generational trends indicated Millennials and Generation Z favored longer, straighter noses with augmented radix and reduced rotation. Across populations, overall facial harmony was consistently prioritized over isolated measurements. Notable contradictions and the underrepresentation of Black populations highlighted key limitations. Nasal aesthetic preferences are dynamic and context dependent. Surgeons should adopt a personalized, culturally sensitive approach to rhinoplasty, prioritizing timeless harmony over transient fashions. Future research must expand inclusivity, employ standardized measurement tools, and leverage emerging technologies to track evolving ideals and assess psychosocial outcomes. Level of Evidence: 3 (Therapeutic).