Rhinoplasty – A Patient’s Perspective

Rhinoplasty – A Patient’s Perspective

Rhinoplasty has a low patient satisfaction rate when compared to other cosmetic procedures, owing to the difficulty of the procedure and potentially unrealistic patient expectations.
Understanding the causes of patient dissatisfaction is critical to improving outcomes. To assess rhinoplasty success, previous authors conducted surgeon-initiated surveys, expert ratings, and morphologic measurements. No study has examined online patient reviews to determine the causes of rhinoplasty dissatisfaction.


The purpose of this study was to examine rhinoplasty satisfaction patterns using online reviews.


All primary rhinoplasty reviews on RealSelf (Seattle, WA), a social media website for cosmetic surgery patients, were examined.
The researchers noted the gender of the patients, whether they were satisfied, and the reasons for their satisfaction or dissatisfaction.
Using chi-squared analysis, male and female patients were compared.


Primary rhinoplasty received 2326 reviews (2032 females, 294 males).
Overall, 83.6% of people were satisfied.
Females were significantly more satisfied than males (87.6% vs 56.1%, P.001).
The most common reasons for dissatisfaction among males were a residual dorsal hump, an under-rotated tip, and a nose that was too small.
The most common reasons for dissatisfaction among females were residual dorsal hump, under-rotated tip, and bulbous tip.
Females were significantly more likely than males to precisely verbalize the morphologic or functional reason for their dissatisfaction among dissatisfied patients.



We discovered that males were less satisfied with rhinoplasty and were more vague in expressing their reasons for dissatisfaction than females.
Social media offers a novel way to learn about the causes of patient dissatisfaction after cosmetic surgery.

Rhinoplasty is still one of the most challenging plastic surgical procedures to master.
The interactions between cosmetic and functional concerns, as well as competing three-dimensional forces, can be intimidating for a young plastic surgeon.
Furthermore, patient dissatisfaction with rhinoplasty remains relatively high.

There are several methods for measuring rhinoplasty outcomes, none of which are without bias.
Some authors have asked their patients to rate their level of satisfaction with the procedure directly.

Patients may be reluctant to express their true reasons for dissatisfaction to their surgeon, so such surgeon-initiated patient surveys may be biased in favor of the procedure.
For example, a patient who believes that his or her surgeon did not listen to his or her concerns may choose not to respond to a questionnaire that her surgeon may review.

Other authors have used expert ratings of the cosmetic outcome as a success indicator.

Expert ratings of the cosmetic outcome; however, the patient’s opinion of the outcome is not taken into account.
In fact, surgeons and patients frequently disagree on the cosmetic outcome of rhinoplasty.

Other authors, however, have used anthropometric measurements of facial landmarks as well as functional measurements to assess the outcome.

While such measurements may provide objective data that makes it easier to compare postoperative to preoperative measurements quantitatively, they do not take the patient’s preferences into account.
Furthermore, objective measures of success may not always accurately predict patient satisfaction.

Customer satisfaction is the ultimate goal of any service provided for a fee.
Social media has emerged as a medium for customers to rate their satisfaction with a specific service provider and express the reasons for their rating over the last ten to twenty years.
Such ratings serve as a guide for customers thinking about purchasing a particular product, and thus constitute credible “electronic word-of-mouth.”

It is estimated that 80% of US consumers use online reviews to help them make purchasing decisions.

This is significantly higher than any other traditional source of consumer feedback.
Online reviews have been shown to influence purchasing behavior.
Several studies have shown that positive online reviews increase sales15,16 while negative reviews deter consumers and reduce sales.

Similar findings have been reported in the healthcare industry, with more than 60% of consumers reporting having sought online advice on a medical issue.

Social media, specifically online physician reviews, has become critical to the success of a cosmetic practice.

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    Seattle Nose Surgeon ®
    William Portuese MD
    Joseph Shvidler MD

    Seattle, Washington 98104

    (206) 624-6200

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