Assessment of Rhinoplasty Outcomes With FACE-Q Rhinoplasty Module

Norwegian Linguistic Validation and Clinical Application in 243 Patients

Amin Kalaaji, MD, PhD; Stine Dreyer, MS; Jakob Schnegg; Lena Sanosyan, MD; Tatjana Radovic, MD; Ivana Maric, MD


Plast Reconstr Surg Glob Open. 2019;7(9):e2448 

In This Article

Abstract and Introduction


Background: Patient satisfaction after rhinoplasty is a growing area of research. The FACE-Q Rhinoplasty Module, used to assess these values, requires translation to national languages.

Methods: Fourteen questions assessing the Satisfaction with Nose Scale and Adverse Effects Checklist of FACE-Q Rhinoplasty Module were translated to Norwegian with adherence to the Mapi Research Trust guidelines. Answers were processed by QuestBack anonymously. Of the 243 patients undergoing rhinoplasty at Oslo Plastic Surgery Clinic, 214 patients were reachable by e-mail.

Results: Response rates to the pre- and postoperative questionnaire were 23% and 32%, respectively. Responses for somewhat or very satisfied with the nose (pre- versus postoperative) were: overall size of the nose (16.3% versus 61.7%); how straight the nose looks (22.4% versus. 58.3%); how well the nose suits the face (12.2% versus 60%); length of the nose (20.4% versus 68.4%); width of the nose at the bottom (26.6% versus 55%); bridge of the nose (14.3% versus 55%); how the nose looks in photographs (10.2% versus 50%), and tip of the nose (16.3% versus 48.3%). Adverse effects (pre- versus postoperative) were moderate or extreme difficulty breathing through the nose (28.6% versus 35%); tenderness (6.1% versus 23.7%); skin of the nose looking thick or swollen (14.6% versus 30.5%); and unnatural bumps or hollows on the nose (55.1% versus 53.3%).

Conclusions: Satisfaction levels in rhinoplasty patients are not as high as in other cosmetic surgery procedures, such as breast augmentation. However, compared with baseline, satisfaction levels showed great improvement postoperatively. The Rhinoplasty Module seems useful in evaluating outcome of rhinoplasty. We encourage application of this clinical outcome of rhinoplasty in and among centers.


The nose is a distinctive facial feature of immense aesthetic importance to the identity of every human being.[1] To achieve optimal facial beauty, the nose must fit the face harmoniously and inconspicuously. However, the nose is not just a facial beauty feature, but a critical sensory organ vital to one of the essential functions of life: breathing.[2] Rhinoplasty is one of the most complex procedures in plastic surgery.[3–5] It is also one of the earliest known surgeries performed to increase a patient's quality of life (QoL) after a disease-or trauma-related deformity of the nose by restoring functional and aesthetic capacities.[6] Despite a 2% decrease in the number of rhinoplasties performed, this procedure still remains one of the most popular cosmetic plastic surgeries. In 2017, more than 218,000 nose-reshaping operations were performed in the United States.[7]

The ultimate goal of aesthetic rhinoplasty is to create a harmonious and natural-appearing nose that assimilates into the surrounding face with no visible sign of previous intervention and that allows a patient to breathe comfortably without restriction.

Postoperative complications and mortality rates have traditionally served as mainstay in clinical outcome research.[8] Though the importance of these measures remains, evaluation of patient satisfaction and QoL are becoming increasingly relevant in cosmetic and reconstructive surgery.[8–13] Comprehensive assessment of surgical outcome demands rigorously developed patient questionnaires that have sufficient reliability, validity, and responsiveness,[8] as these would facilitate the comparison of techniques, the quantification of positive outcomes, and allow for identification of individuals that most likely benefit from the respective surgery.[11,12] As implied by Pusic et al,[8] data yielded from patient questionnaires that are not psychometrically tested ("ad hoc questionnaires") may not be viable for making confident conclusions on the impact and effectiveness of plastic surgery due to lacking reliability and validity.

Many studies are performed to evaluate the effects of rhinoplasty on the patients' life,[14] for which several questionnaires are used (e.g., Rhinoplasty Outcome Evaluation;[15] Sino-Nasal Outcome Test;[16] Nasal Obstruction and Septoplasty Effectiveness Scale[17]). However, information on structural validity and internal consistency are lacking for many of these instruments,[18] and none includes a wide variety of questions to evaluate separate parts of the nose and how this feature reflects QoL before and after surgery.

The FACE-Q rhinoplasty module[19] is an instrument designed to evaluate patient-reported outcomes (PRO) before and after undergoing rhinoplasty and to assess adverse effects regarding the nose. This module requires translation to national languages.[20]

The present study was conducted to evaluate patient satisfaction with the outer appearance of the nose, its function, and changes. The first of our 2 main goals was to apply an internationally validated tool for rhinoplasty to evaluate the outcomes of the procedure. This article is a detailed guide for rhinosurgeons who want to validate the FACE-Q rhinoplasty module in their country, including the whole translation process: stages and nuances, validation process, and study methods. By using this tool in daily practice, surgeons are able to collect fully anonymous responses from patients and build solid evidence-based data regarding their methods, techniques, and strategies. The second goal was to measure QoL of patients in relation to rhinoplasty. Patients were given an opportunity to rate how their satisfaction with the nasal appearance has changed after surgery. Moreover, we believe that common adverse events of rhinoplasty are also an important aspect to be considered when discussing changes in QoL. The anonymous style of the evaluation ensured honesty and objectivity from the patients when answering the questions. In light of the fact that many publications reporting technical details often do not include satisfaction of PRO conducted anonymously, we hope this work will contribute new knowledge to the rhinoplasty field.