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Original Investigation
Sept/Oct 2018

Association of Dorsal Reduction and Tip Rotation With Social Perception

Author Affiliations
  • 1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head & Neck Surgery, Stanford University School of Medicine, Stanford, California
  • 2Department of Physical and Rehabilitation Medicine, Turku University Hospital, University of Turku, Turku, Finland
  • 3Division of OtolaryngologyUniversity HospitalHead and Neck Surgery, Department of Surgery, Université de Montréal, Montréal, Québec, Canada
JAMA Facial Plast Surg. 2018;20(5):362-366. doi:10.1001/jamafacial.2018.0317
Key Points

Questions  What are the differences in social perception of people who undergo cosmetic rhinoplasty for dorsal hump reduction, tip rotation, or both?

Finding  From a web-based survey of 840 respondents, a significant association was found for age, approachability, attractiveness, and health for hump reduction, and attractiveness and health for combined dorsum and tip rotation. No significant association was found for any of the responses when the tip alone was rotated with or without manipulation of the dorsum.

Meaning  Rhinoplasty procedures for nasal cosmesis involving dorsal reduction with or without tip manipulation were perceived to make a person more attractive and healthier, and dorsal reduction had a greater effect than tip manipulation in adding value to social perception of the facial profile.


Importance  Social perception by laypersons of people who have undergone rhinoplasty primarily for cosmetic purposes has not been fully described.

Objective  To evaluate the social perception of patients who have undergone cosmetic rhinoplasty.

Design, Setting, and Participants  Preoperative images of 4 patients with dorsal hump and tip ptosis were selected using the Delphi method. Computer simulations of dorsal hump reduction and tip rotation, alone or in combination, were performed. Using the Qualtrics internet-based survey platform, laypersons blinded to the purpose of the study viewed randomized original and simulated images and estimated the age, approachability, perceived success, overall health, intelligence, and rated their attractiveness on a visual analog scale from 0 to 100.

Main Outcomes and Measures  Comparison of responses (mean [SD] score) for each of the 3 types of simulated image against the original image employing a pairwise comparison of means (Dunnett test).

Results  After excluding 27 (4%) invalid responses, a total of 813 respondents (593 women and 220 men) were included in the study. The mean (SD) age was 44.6 (16.2) years. A total of 628 (77%) respondents were white and the observed highest level of education was a bachelor’s degree (193 [24%]) or having attended college but without a diploma (194 [24%]). A significant age reduction (31 [10] years; 95% CI, −2.5 to 0; P = .04) and an increase in approachability (64 [22]; 95% CI, 0.7-5.8; P = .009), attractiveness (60 [22]; 95% CI, 4.0-9.4; P < .001), and health (70 [19]; 95% CI, 0.7-5.2; P = .006) for the simulation involving hump reduction was observed. When combined simulation of dorsum and tip rotation were tested, only significant increases in attractiveness (60 [23]; 95% CI, 3.6-9.0; P < .001) and health (69 [19]; 95% CI, 0.1-4.6; P = .03) were seen. No significant association was found for any of the responses when the tip alone was rotated. The Wilks λ varied slightly below 1.0 showing significant P values (P < .05) for all variance and covariance (respondent particulars).

Conclusions and Relevance  Though rhinoplasty procedures for nasal cosmesis involving both the nasal dorsum and tip were perceived to make a person more attractive and healthier, these results suggest that manipulation of the dorsum is more strongly associated with perception of the nose.

Level of Evidence  NA