Ferreira Miguel Gonçalves, Santos Mariline, Carmo Diogo Oliveira E, Neves José Carlos, Sousa Cecília Almeida E, Datema Frank R
Department of Otolaryngology, Head and Neck Surgery, Centro Hospitalar Universitário do Porto and Hospital Luz Arrábida, Porto, Portugal.
Department of Otolaryngology, Head and Neck Surgery, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Facial Plast Surg. 2018 Aug;34(4):356-362. doi: 10.1055/s-0038-1660823. Epub 2018 Jul 24.
One of the key points of a successful rhinoplasty is communication between the patient and surgeon. The surgeon needs to get a clear understanding of the patient's motivation for surgery and expectations of the procedure. This information is mandatory in formulating an optimal surgical plan and managing realistic expectations of the procedures. Ideally, surgeons and patients see, discuss, and quantify the same nasal defects. In reality, the subjective nature of perceiving aesthetics can cause variability of inter-rating nasal appearance. Therefore, one might question how well surgeons understand their patients. Do they see what patients see? The aim of this study is to assess the level of agreement on the evaluation of nasal appearance between patients, surgeons, and nonphysicians observers, and try to find predictive factors that cause high interobserver variability. This prospective, observational, and cross-sectional study was performed on a total of 100 randomized patients undergoing rhinoplasty. All patients were photographed before surgery and asked to rate the appearance of their nose on a 10 cm visual analogue scale (VAS) with 0 indicating very ugly and 10 indicating very nice. Subsequently, the photographs of each patient were, independently, rated by two panels: one constituted by two rhinoplasty surgeons and the other by four nonmedical raters. Both panels included European raters from the north (The Netherlands) and south (Portugal). Data regarding age, gender, skin type, and major nasal deformity were also collected. The authors found that there is no statistical agreement between the aesthetical evaluation of the nose between patients and surgeons or patients and nonmedical raters. Based exclusively on the VAS for subjective evaluation of nasal appearance, the authors' findings show that surgeons and patients do not "see the same" and generally, the score attributed by the surgeon is more favorable (almost 1 point higher) than the auto-assessment's score. This is important to realize when communicating about nasal appearance before rhinoplasty.
成功隆鼻的关键要点之一是患者与外科医生之间的沟通。外科医生需要清楚了解患者的手术动机以及对手术的期望。这些信息对于制定最佳手术方案和管理对手术的现实期望至关重要。理想情况下，外科医生和患者能看到、讨论并量化相同的鼻部缺陷。但实际上，审美认知的主观性会导致对鼻部外观评分的差异。因此，人们可能会质疑外科医生对患者的理解程度。他们看到的和患者看到的一样吗？本研究的目的是评估患者、外科医生和非医生观察者在鼻部外观评估上的一致程度，并试图找出导致观察者间差异较大的预测因素。这项前瞻性、观察性横断面研究共纳入了100例接受隆鼻手术的随机患者。所有患者在手术前均拍照，并被要求在10厘米视觉模拟量表（VAS）上对自己鼻子的外观进行评分，0表示非常丑，10表示非常好看。随后，每位患者的照片由两个小组独立评分：一个小组由两名隆鼻外科医生组成，另一个小组由四名非医学评分者组成。两个小组都包括来自北方（荷兰）和南方（葡萄牙）的欧洲评分者。还收集了有关年龄、性别、皮肤类型和主要鼻部畸形的数据。作者发现，患者与外科医生之间或患者与非医学评分者之间在鼻子美学评估上没有统计学上的一致性。仅基于VAS对鼻部外观进行主观评估，作者的研究结果表明，外科医生和患者“看法不同”，一般来说，外科医生给出的分数更有利（几乎高1分），这在隆鼻手术前就鼻部外观进行沟通时很重要。
