We read with great interest the article by Fang Yang, M.D.,1 published in the March issue of the Journal. We agree with the authors to affirm that cosmetofunctional rhinoplasty improves patients’ quality of life. The authors used the Rhinoplasty Outcomes Evaluation questionnaire.
In 2017, we published a review about patient-reported outcome measures following rhinoplasty2 and concluded that the Rhinoplasty Outcome Evaluation questionnaire, the Functional Rhinoplasty Outcome Inventory 17, the Rhinoplasty Health Inventory and Nasal Outcomes Scale, and the Expectations of Aesthetic Rhinoplasty Scale survey are developed for both functional and cosmetic aspects of rhinoplasty, but they do not have a complete development and they do not respect all of the criteria according to international guidelines for the development and validation of health outcome questionnaires, as outlined by the Scientific Advisory Committee of the Medical Outcomes Trust and the U.S. Food and Drug Administration. In the literature, only the FACE-Q rhinoplasty module by Klassen et al.,3 which we use in our practice, satisfies all items according to international guidelines, although it can only be used to evaluate cosmetic or psychosocial aspects, and is not helpful in preoperative and postoperative functional evaluations. The preoperative and postoperative FACE-Q rhinoplasty module, published in 2016, is a rigorously developed, nose surgery–specific, patient-reported outcome instrument that has been validated by Rasch measurement theory analysis, leading to the refinement of a 10-item satisfaction with nose scale and a five-item satisfaction with nostrils scale. The person separation index and Cronbach α were 0.91 and 0.96, respectively, for the satisfaction with nose scale and 0.89 and 0.96, respectively, for the satisfaction with nostrils scale. All items had ordered thresholds and good item fit. So why did the authors choose the Rhinoplasty Outcome Evaluation questionnaire? The statistical analysis is well done and with very interesting results. In particular, the authors observed that the change in Rhinoplasty Outcomes Evaluation questionnaire scores was presented based on age group (≤30 years and ≥30 years). We agree with this result; in fact, in our clinical practice, these two groups of patients are the most satisfied but with different requests before the procedure. We published an article about rhinoplasty in elderly patients.4 From June of 2016 to May of 2017, the Italian version of the FACE-Q rhinoplasty module was given to 25 elderly patients preoperatively and postoperatively and to 25 younger patients (control group), for comparison. All patients answered the postoperative module 6 months after their procedure. The most noticeable result was in tip perception, in fact, in the group older than 65 years. The tip of the nose is the focus of attention for older patients who want to undergo this operation and require surgical procedures for increased projection and support.
As the implementation of evidence-based medicine spreads in routine practice, there is increasing pressure to adopt validated survey instruments to demonstrate patient-reported outcomes.5 Using qualitative methods to elicit patient stories and then using these stories to develop patient-reported outcome instruments, we are taking a best practice approach that ensures content validity. Although a patient-reported outcome measure instrument may be shown to have excellent psychometric properties, if it fails to measure the issues that matter the most to patients, it will not be useful in clinical practice, research, or quality improvement initiatives.
The authors have no commercial associations that might pose or create a conflict of interest with information presented in this communication. No intramural or extramural funding supported any aspect of this work.
Mauro Barone, M.D.Annalisa Cogliandro, M.D., Ph.D.Paolo Persichetti, M.D., Ph.D.Plastic and Reconstructive Surgery UnitCampus Bio-Medico University of RomeRome, Italy
1. Yang F, Liu Y, Xiao H, Li Y, Cun H, Zhao Y. Evaluation of preoperative and postoperative patient satisfaction and quality of life in patients undergoing rhinoplasty: A systematic review and meta-analysis. Plast Reconstr Surg. 2018;141:603611.
2. Barone M, Cogliandro A, Di Stefano N, Tambone V, Persichetti P. A systematic review of patient-reported outcome measures after rhinoplasty. Eur Arch Otorhinolaryngol. 2017;274:18071811.
3. Klassen AF, Cano SJ, East CA, et al. Development and psychometric evaluation of the FACE-Q scales for patients undergoing rhinoplasty. JAMA Facial Plast Surg. 2016;18:2735.
4. Barone M, Cogliandro A, Cassotta G, et al. Rhinoplasty in elderly patients: Analysis of outcomes and patient’s satisfaction following 20 years experiences. Eur J Plast Surg. 2018;41:395400.
5. Barone M, Cogliandro A, La Monaca G, Tambone V, Persichetti P. Cognitive investigation study of patients admitted for cosmetic surgery: Information, expectations, and consent for treatment. Arch Plast Surg. 2015;42:4651.