We greatly appreciate the response from Drs. Barone, Cogliandro, and Persichetti regarding our work on the impact of rhinoplasty on how patients are perceived.1 Aesthetic “standards” can indeed fall into the trap of complete subjectivity or a false confidence in objectivity. We applaud the effort to develop a novel concept, so-called Appearance Pain, and the effort to capture the multidimensional aspects of appearance and perception, a subject of great interest.2 We recognize that our study utilized subjective measures (evaluator’s assessments) across a broad base of people toward building a consensus judgment on a patient’s postoperative appearance compared to her preoperative appearance. Large numbers and data analysis could indeed lead to tenuous claims of wider objectivity, which could potentially establish unreasonable or false expectations in patients. Our study should not be misinterpreted or misapplied in a way that suggests guaranteeing patients a specific relational, psychological, or social outcome.
Aesthetic judgments and decisions have escaped objectivity for millennia; the modern intersection of aesthetics and substantial surgical intervention calls for high standards on the part of the surgeon to counsel, screen, and prepare patients for the proposed procedure and its sequelae. We look forward to further clarification of App-Pain and its implementation in clinical practice.
Neither of the authors has a financial interest to declare in relation to the content of this communication.
Stephen M. Lu, M.D., M.Div.
Neil Tanna, M.D., M.B.A.
Division of Plastic and Reconstructive Surgery
Hofstra Northwell School of Medicine
1. Lu SM, Hsu DT, Perry AD, et al. The public face of rhinoplasty: Impact on perceived attractiveness and personality. Plast Reconstr Surg. 2018;142:881–887.
2. Lu SM, Bartlett SP. On facial asymmetry and self-perception. Plast Reconstr Surg. 2014;133:873e–881e.
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