Assessment of Wellbeing and Anxiety-Related Disorders in Those Seeking Rhinoplasty: A Crowdsourcing-Based Study

Goals/Purpose: Physical appearance of the face plays a critical role in the social life of a person. Several studies concluded that there is a direct correlation between a patient and their self-image, which can be drastically altered by the perceptions of others. This can have a negative effect on the self-esteem of a patient, resulting in anxiety, depression, and other psychological disorders, and subsequently social avoidance which may exacerbate these conditions. Recently, it has been proposed that psychosocial concerns may motivate the demand for aesthetic rhinoplasty. Although successful operations often improve the quality of life and self-esteem symptoms in patients with sound mental health, they may actually result in unsatisfactory outcomes in those patients with significant depression, anxiety, or other severe psychological disorders. As such, the purpose of this study was to assess the incidence of psychological disorders in patients seeking rhinoplasty.

Methods/Technique: A prospective cross-sectional study of 298 random volunteers was conducted, with each participant completing a survey instrument that was administered through an internet crowd-sourcing service (Amazon Mechanical Turk©). Participants were asked to complete a 10-item standardized SHNOS scale, and a 26-question PRIME-MD questionnaire in order to assess functional and aesthetic need for rhinoplasty, and the incidence of psychological disorders respectively. Participants were also asked to assess their satisfaction with the overall appearance of their nose both before and after administration of the survey in order to evaluate response bias.

Results/Complications: A total of 298 volunteers successfully completed the survey, with only 5.03% of survey participants demonstrating a response bias after completing the PRIME-MD questionnaire. With respect to gender, 38.95% of female participants reported a willingness to undergo aesthetic rhinoplasty, with a significantly lower number of men reporting the same (27.78%, p = 0.042). There was also a significantly higher percentage of young adults between the ages of 18-24 (52.92%) willing to undergo aesthetic rhinoplasty, as compared to any other age group (p < 0.01). Income further demonstrated a significant role in the willingness to undergo aesthetic rhinoplasty, with 47.37% of individuals with annual household income of $50,000-$75,000 interested in rhinoplasty, while only 32.41% of individuals with income less than $50,000 interested in rhinoplasty (p = 0.033). Of those participants that were satisfied with the overall appearance of their nose, 15.32% still reported a willingness to undergo aesthetic rhinoplasty. Furthermore, 57.84% of patients interested in surgery reported a psychological disorder as determined by the PRIME-MD questionnaire.

Conclusion: The results of this study, as a reflection of the general US population, demonstrate that a majority of individuals interested in aesthetic rhinoplasty may be suffering from a mental disorder. Those suffering from major depressive disorder, generalized anxiety disorder, or body dysmorphic disorder may seek aesthetic rhinoplasty as a solution. As such, is important that surgeons assess patient mental health prior to treatment in order to avoid unsuccessful outcomes secondary to psychosocial illness.