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In order to correct severe septal deformities, complete septal reconstruction is often required to achieve the desired functional and aesthetic results. Several different techniques have been described. Systematic evaluation of the long-term results is crucial to assess and improve the quality of these surgical techniques. A custom-built dashboard (the rhinoplasty health care monitor [RHM]) was used for prospective and longitudinal outcome evaluation of the septal reconstruction. The RHM includes the Nasal Obstruction Symptom Evaluation (NOSE) scale for nasal obstruction and the Utrecht Questionnaire (UQ) for aesthetic outcome results. In total, 58 patients were included for septal reconstructive surgery. The mean preoperative NOSE scale scores decreased from 67.8 ± 19.1 to 12.2 ± 17.5, 1 year after surgery. Mean preoperative UQ scores went from 12.3 ± 6.4 to 6.2 ± 2.7. The beneficial functional and aesthetic effects of the techniques that we currently use to reconstruct the septum are efficient in terms of function and aesthetics., Competing Interests: None declared., (Thieme. All rights reserved.)

Presently, there is no consensus on which patient-reported outcome measurement (PROM) instrument is best suited to assess the aesthetic outcomes of rhinoplasty. In this regard, at least seven different validated PROMs are available from the literature, each one with advantages and disadvantages.In this article, we review the development, validation, international translation, and clinical application of the Utrecht Questionnaire (UQ). The UQ was developed in 2009 with the idea to be a short and practical tool for the rhinoplasty surgeon to assess the aesthetic outcomes of rhinoplasty. The questionnaire was then validated in 2013. Body image in relation to nasal appearance is quantified with five simple questions on a 5-point Likert scale and a Visual Analogue Scale score. We discuss how the UQ can easily be incorporated and become an important asset in a rhinoplasty practice. Practical benefits, such as its role in the shared decision-making process, patient expectations management, identification of unsuitable patients, avoiding revision surgery, and the evaluation of the surgeon's personal performance curve, are exemplified. Currently, the UQ has been translated and validated in four languages, providing scientific opportunities to generate and compare international data for advances in rhinoplasty. We describe some of the significant scientific contributions of leaders in the field of rhinoplasty that used the UQ., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Self-assessment provides valuable feedback in the life-long process of mastering rhinoplasty. This study presents a method to measure and evaluate data-based performance of a single surgeon using a web-based dashboard. Methods: In this prospective analytic cohort study, all patients referred to the senior author for functional-aesthetic (revision) rhinoplasty between April 2014 and September 2020 are included. Patients completed the Nasal Obstruction Symptom Evaluation (NOSE) scale, Utrecht Questionnaire (UQ), and visual analog scales before and after rhinoplasty. Questionnaire scores were exported to a customized web-based dashboard: the rhinoplasty health care monitor. Supported by real-time graphic output, this monitor automatically analyzes functional and aesthetic outcomes. Results: Of 603 referred patients, 363 were eligible for rhinoplasty. Mean NOSE scale scores decreased from 66.6 ± 23.5 to 23.2 ± 24.0 ( p  < 0.001), and mean UQ scores decreased from 12.2 ± 6.3 to 7.1 ± 3.9 ( p  < 0.001) 1 year after surgery. The rhinoplasty health care monitor visualizes numerous outcome parameters that help the surgeon to analyze results, identify learning needs, and detect trends in performance development. Conclusions: This automated outcome dashboard transparently measures individual surgeon performance. Gauging performance provides means to enhance surgical development and, consequently, patient satisfaction.

Background: The aesthetic ideal of the nose eludes clear definition. Averageness may be an important determinant of ideal nasal shape: research has shown that averageness plays an important role in the human perception of facial attractiveness., Objectives: The aim of this study was to test whether an averaged nasal shape is attractive, and whether deviation away from average is associated with decreased attractiveness., Methods: Photographic series of the face were obtained from 80 Caucasian female volunteers aged 25-40 years. A mathematically averaged composite image was created from the first 40 volunteers. Forty-one panel members were recruited to judge the attractiveness of the nose of each original image and the composite, based on a 5-point Likert scale ranging from 1 (very ugly) to 5 (very pretty). Deviation of nasal shape from average was calculated by principal components analysis of standardized nasal landmarks., Results: Twenty-one respondents were male (51%). The mean age of the respondents was 35.3 [15.6] years. The rating of the composite was significantly higher than the distribution of ratings for the 80 original nose images (4.2 vs 2.8, t = 31.24, P < 0.001). The rating of the original nose images correlated negatively with deviation from average shape (r = -0.40, n = 80, P < 0.001)., Conclusions: In Caucasian females, a mathematically averaged nose is an attractive nose. Furthermore, the more an individual nose shape resembles the average shape, the more attractive it is rated. Calculating deviation from average before and after rhinoplasty may aid in objectively measuring aesthetic rhinoplasty outcome., (© 2020 The Aesthetic Society. Reprints and permission: journals.permissions@oup.com.)

Introduction: The evaluation of surgical outcomes measured by patient satisfaction or quality of life is very important, especially in plastic surgery. There is increasing interest in self-reporting outcomes evaluation in plastic surgery., Objective: The aim of this study was to perform the translation, cross-cultural adaptation and validation of "The Utrecht questionnaire for outcome assessment in aesthetic rhinoplasty" from English to Portuguese., Methods: Retrospective study involving 50 patients undergoing to rhinoplasty comparing the preoperative period with the current postoperative situation (minimum 6 months and maximum 24 months postoperatively). Statistical analysis was performed to assess internal consistency, test-retest reliability, validity and responsiveness., Results: No patients received a negative score on the visual analogue scale comparing preoperative and postoperative appearance. The postoperative improvement on the visual analogue scale revealed a Gaussian curve of normal distribution with a mean improvement of 4.44 points. The test-retest reliability showed a positive correlation between the postoperative response and the same questionnaire repeated ninety-six hours later. The internal consistency was high (Cronbach's alpha value: Preoperative=0.88; Postoperative=0.86). The authors observed a significant improvement in response for all individual questions in the postoperative phase as compared with preoperative situation (t-student test - p<0.05)., Conclusion: The Portuguese version of "The Utrecht questionnaire for outcome assessment in aesthetic rhinoplasty" is a valid instrument to assess patients' outcomes following rhinoplasty surgery., (Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Background: Patients, governments, health care providers, and insurance companies are increasingly interested in medical performance. Transparent outcome reporting requires a thorough methodologic design, dedicated prospective data collection process, and preferably no interference with the efficacy of daily practice. The primary aim of this article is to describe how these bottlenecks are tackled with an automated prospective rhinoplasty outcome routine. The secondary aim is to motivate others by describing practical benefits encountered during implementation., Methods: Since April 2014, 269 consecutive patients referred for functional-aesthetic (revision) rhinoplasty were included. The Nasal Obstruction Symptom Evaluation scale, the Utrecht Questionnaire, and visual analogue scales were offered to all patients before primary consultation and follow-up to translate the subjective burden of nasal problems and change herein following surgery, into data. These data were exported for real-time automated outcome analysis supported by graphic output through a customized Web-based dashboard., Results: One hundred seventy-one patients proved eligible for rhinoplasty, of which 121 had sufficient follow-up. The dashboard provides an overview of demographic characteristics of different populations, reasons why rhinoplasties were not performed, and real-time short- and long-term change in functional and aesthetic outcome in both primary and revision cases. Practical benefits of the instruments used are presented and discussed., Conclusions: Routine prospective outcome monitoring provides an evidence-based response to the increasing demand for transparency in health care. The dashboard proved valuable during patient counseling, patient selection, and management of expectations and has the potential to compare rhinoplasty results between surgeons and institutions, provided that the populations share similar characteristics., Clinical Question/level of Evidence: Therapeutic, IV.

Background: The authors tested a short, practically designed questionnaire to assess changes in subjective perception of nasal appearance in patients before and after aesthetic rhinoplasty., Methods: A prospective cohort study was conducted in a group of 121 patients who desired aesthetic rhinoplasty and were operated on by one surgeon. The questionnaire contained five questions (E1-E5) based on a five-point Likert scale and a visual analogue scale (range, 0 to 10). Two questions were designed as trick questions to help the surgeon screen for signs of body dysmorphic disorder., Results: All patients rated the appearance of their nose as improved after surgery. The visual analogue scale revealed a Gaussian curve of normal distribution (range, 0.5 to 10) around a significant improvement (mean, 4.36 points, p = 0.018). Also, question E1, question E2, and the sum of questions E1 through E5 showed a statistically significant improvement after surgery (p = 1.74 × 10, p = 4.29 × 10, and p = 9.23 × 10, respectively). The authors found a linear relationship between preoperative score on the trick questions and postoperative increase in visual analogue scale score. Test-retest reliability could be investigated in 74 of 121 patients (61 percent) and showed a positive correlation between postoperative (1 year after surgery) and repostoperative response (2 to 4 years after surgery)., Conclusions: The authors concluded that a surgeon performing aesthetic rhinoplasty can benefit from using this questionnaire. It is simple, takes no more than 2 minutes to complete, and provides helpful subjective information regarding patients' preoperative nasal appearance and postoperative surgical outcome., Clinical Question/level of Evidence: Therapeutic, IV.