INTRODUCTION: Physical appearance of the face plays a critical role in the social life of a person. Several studies have 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 further exacerbate these conditions. Recently, it has been proposed that psychosocial concerns may motivate the demand for esthetic 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 mental illness in patients seeking rhinoplasty.
METHODS: A prospective cross-sectional study of 298 random volunteers was conducted, with each participant completing a survey instrument that was administered through an internet crowdsourcing service (Amazon Mechanical Turk). Participants were asked to complete a 10-item standardized SHNOS scale and a 26-question PRIME-MD questionnaire to assess functional and esthetic 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 to evaluate response bias.
RESULTS: 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 esthetic 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 18 and 24 years old (52.92%) willing to undergo esthetic rhinoplasty, as compared to any other age group (P < 0.01). Income further demonstrated a significant role in the decision to seek esthetic rhinoplasty, with 47.37% of individuals with annual household income of $50,000–$75,000 interested in surgery, whereas only 32.41% of individuals with income <$50,000 interested in rhinoplasty (P = 0.033). Of those participants who were satisfied with the overall appearance of their nose, 15.32% still reported a willingness to undergo esthetic otoplasty. Furthermore, 57.84% of patients interested in surgery reported a psychological or mental health disorder as determined by the PRIME-MD questionnaire.
CONCLUSIONS: The results of this study, as a reflection of the general US population, demonstrate that a majority of individuals interested in esthetic rhinoplasty may be suffering from a mental health disorder. Those suffering from major depressive disorder, generalized anxiety disorder, or body dysmorphic disorder may seek esthetic rhinoplasty as a solution to their perceived psychosocial problems. As such, it is important that surgeons assess patient mental health before treatment to avoid unsuccessful outcomes secondary to mental illness.