Perception of Symmetry in Aesthetic Rhinoplasty Patients: Anthropometric, Demographic, and Psychological Analysis

Visual perception of symmetry is a major determinant of satisfaction after aesthetic rhinoplasty. In this study, we sought to investigate the existence of any relationship between anthropometric characteristics of the face and visual perceptions of asymmetry among rhinoplasty patients and to evaluate tools that can shed light on patients who appear at high risk for exaggerating potential asymmetries. In the first part, 168 rhinoplasty patients were asked to fill out the demographic questionnaire, nasal shape evaluation scale, and the somatosensory amplification scale. In the second part, we examined the relationship between anthropometric characteristics of the face and visual perceptions of asymmetry using standardized photographs of 100 medical students. In the third part, patients answered the rhinoplasty outcome evaluation questionnaire 6 months after the surgery. Objectively, no symmetrical face was observed in the anthropometric evaluation. Subjectively, only 73% and 54% of the faces were considered asymmetrical by the rhinoplasty and the control groups, respectively. The rate of asymmetry perception was significantly greater in revision patients when compared with primary rhinoplasty patients. The relationship between the rate of subjective perception of asymmetry and the somatosensory amplification scale scores was statistically significant. We found a significant inverse relationship between the rate of asymmetry perception and the rhinoplasty outcome evaluation scores. Plastic surgeons should be aware of this high selectivity in asymmetry perception, which is associated with poor postoperative satisfaction. Somatosensory amplification scale may help identify rhinoplasty patients at a high risk for exaggerating potential asymmetries. Level of Evidence: III.