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Predicting Rhinoplasty

Dr. Philip Miller

July 6, 2016

rhinoplasty results in NYC, NY A major problem for many rhinoplastic surgeons is the ability to predict, before surgery, the difficulty of the procedure (whether the rhinoplasties will be technically easy or technically difficult to perform) and the success rate of the result (whether the rhinoplasty will likely give good results or poor ones).

The present paper outlines a systematic approach to nasal analysis, allowing the surgeon to consistently estimate, before surgery, the degree of technical difficulty of each rhinoplasty, as well as predicting its future result in terms of patient satisfaction. This preoperative evaluation is based on the analysis of the skin texture and the osteocartilagenous framework on lateral and frontal views. It allows for the nose to be classified as green (easy), yellow (moderate) or red (difficult), depending on two factors: the degree of surgical difficulty and the expected patient’s satisfaction with the result.

The essence of the present paper is to introduce a simple, systematic approach to assist the novice rhinoplastic surgeon to assess the complexity, the risks and the expected outcome of a rhinoplasty in the preoperative period, rather than post-operatively.

Several publications have sought to define the psychological profile of the ideal candidate for rhinoplasty and the different techniques associated with rhinoplasty . However, there is no literature addressing preoperative prediction of the technical difficulty and the associated outcome of a rhinoplasty.

While some surgeons tend to consider all rhinoplasties as simple and rewarding procedures, others view them all as technically challenging, complex and unpredictable. The truth lies between the two opinions: some rhinoplasties are technically easy to perform (from the surgeon’s perspective) and tend to give impressive results (from the patient’s point of view), whereas others are difficult to perform (from the surgeon’s perspective) and lead to ‘unimpressive’ results (from the patient’s point of view).

As rhinoplastic surgeons gain experience, they become more comfortable with the technical aspects of the surgery and better equipped to predict its probable outcome at the time of the preoperative assessment. However, for novice surgeons starting their rhinoplasty practice, or surgeons who do not perform a large volume of nasal surgeries, predicting the complexity and results of their rhinoplasties may present a significant challenge.

We propose a simple, systematic approach to the preoperative assessment of the rhinoplastic patient to predict which noses are technically easy or difficult to handle intraoperatively, and which will have a perceived good or suboptimal aesthetic result postoperatively.

We believe that the proper evaluation of the expected complexity of a rhinoplasty, as well as the ability to predict postoperative results preoperatively, are an essential part of the rhinoplastic surgeon’s training. Indeed, the ability to predict satisfaction and results preoperatively may have a significant impact on overall patient satisfaction, referral pattern and, ultimately, the success of a practice.


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Dr. Philip Miller

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