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The Impact of Demographic Differences on Perceived Improvement Following Rhinoplasty
Jonathan A. Schwitzer, BA1, Amie M. Scott, MPH1, Kenneth L. Fan, MD2, Sarah R. Sher, MD2, Andrea L. Pusic, MD1, Stephen B. Baker, MD2.
1Memorial Sloan-Kettering Cancer Center, New York, NY, USA, 2Georgetown University Hospital, Washington, DC, USA.

Background: The ability to detect clinically meaningful change from the patients’ perspective is critical to evaluating satisfaction in rhinoplasty patients. The FACE-Q is a new patient-reported outcome instrument composed of numerous independently functioning scales which measure outcomes for patients undergoing cosmetic facial procedures, including rhinoplasty. The objective of this study is to determine the impact of socio-demographic factors on patient perceived improvement following rhinoplasty.
Methods: As part of the larger FACE-Q validation study, patients presenting for rhinoplasty from a single center in the USA, were asked to complete the following FACE-Q scales: Satisfaction with Facial Appearance, Social Function, and Psychological Well-Being. Patients completed the scales at the time of their preoperative consultation and/or at postoperative visits. FACE-Q scores were assessed for each scale (range 0 - 100), with higher scores indicating greater satisfaction with facial appearance or superior quality of life. Pre and post- treatment scores were compared using paired t-tests based on patient demographics, including age, gender, ethnicity, and household income.
51 rhinoplasty patients completed the FACE-Q scales a total of 80 times (41 pre-op completions and 39 post-op completions). Patients ranged in age from 16 to 61 (mean 30, SD 11.4 years), tended to be female (n=37, 72.5%), White (n=36, 70.6%), and single/unmarried (n=31, 60.8%). An equal number of patients reported annual household income either < or ≥ $100,000 (n=18 for both, 35.3%)
Patient FACE-Q scores increased pre- to post-rhinoplasty among all demographic groups. However, not all increases were statistically significant (p<0.05).
Female patients demonstrated statistically significant increases pre- to post-rhinoplasty in Facial Appearance, Social Function, and Psychological Well-being scores (p<0.01, p=0.045, p<0.01, respectively), while male patients did not (p=0.10, p=0.71, p=0.58).
Patients ≤ 22 years old had statistically significant increases in Facial Appearance, Social Function, and Psychological Well-being scores (p<0.01, p=0.02, p<0.01, respectively), while patients between the ages of 23 to 35 showed statistically significant increases in only Facial Appearance and Psychological Well-being scores (p<0.01, p<0.01) but not in Social Function (p=0.44). Patients older than 35 years old showed no statistically significant improvement in any of the three scores (p=0.06, p=0.34, p=0.37).
Single/unmarried patients showed statistically significant increases in Facial Appearance and Psychological Well-being scores (p<0.01, p<0.01 respectively), while patients who were married or living with a significant other did not (p=0.27, p=0.43).
Patients with a household income ≥ $100,000 showed a statistically significant improvement on all three scale scores (p<0.01 on all three), while patients with a household income < $100,000 showed statistically significant improvement in only Facial Appearance (p<0.01), but not Social Function or Psychological Well-being (p=0.20, p=0.08, respectively).
Conclusions: Satisfaction with facial appearance and improved quality of life are key outcomes for patients undergoing rhinoplasty. In an objective study using a validated patient reported outcome instrument, we were able to quantify differences in clinically meaningful change among rhinoplasty patients based on demographic variables. The use of this model supports the successful outcomes possible in rhinoplasty among numerous groups of patients, while also demonstrating possible differences in outcome based on patient demographics.

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