Patients with anxiety or depression undergoing functional septorhinoplasty experience lower postoperative satisfaction and higher revision rates.
Anxiety and depression do not significantly affect patient-reported satisfaction or revision rates after aesthetic septorhinoplasty.
Both functional and aesthetic septorhinoplasty result in significant symptom and cosmetic improvement in all patient groups.
Study Background
Rhinoplasty remains one of the most common facial plastic surgeries performed to address both functional nasal obstruction and aesthetic nasal deformities. While body dysmorphic disorder (BDD) has been well established as a negative predictor of postoperative satisfaction, the impact of more prevalent mental health conditions such as anxiety and depression on rhinoplasty outcomes is less clearly defined. Considering that mood disorders could influence perception of symptom relief, cosmetic satisfaction, and expectations, examining their roles in septorhinoplasty outcomes is clinically significant. Understanding these associations could improve preoperative counseling and risk stratification for revision surgery.
Study Design
This is a single-center retrospective cohort study conducted from 2019 to 2024. The study analyzed 669 patients who underwent either functional or aesthetic septorhinoplasty. Patient-reported outcomes (PROs) were assessed using validated instruments: Nasal Obstruction Symptom Evaluation (NOSE) for functional outcomes, and the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS), with subscales for obstructive and cosmetic components.
Patients were stratified into groups based on documented preoperative diagnoses of anxiety and/or depression versus controls without these conditions. Outcomes compared included preoperative and postoperative PRO scores as well as revision surgery rates. Multivariable logistic regression was performed to adjust for confounders and evaluate the odds of revision surgery.
Key Findings
Functional Septorhinoplasty Cohort
Among 490 patients undergoing functional septorhinoplasty, both anxiety/depression and control groups showed statistically significant postoperative improvement in NOSE and SCHNOS-Obstructive scores (p<0.001 for both). However, the anxiety/depression group reported significantly higher (worse) postoperative scores: postoperative NOSE scores were 35.3 versus 24.1 (p<0.001), and SCHNOS-Obstructive scores were 32.1 versus 24.1 (p=0.027) compared to controls. This indicates that although improvement occurs, symptom burden and dissatisfaction remain relatively higher in patients with anxiety or depression.
Importantly, patients with anxiety or depression had a greater likelihood of undergoing revision surgery, with an odds ratio of 2.56 (95% CI 1.51-4.39, p<0.001), showing a clinically relevant increased risk that may reflect persistent symptoms or dissatisfaction.
Aesthetic Septorhinoplasty Cohort
For the 179 patients undergoing aesthetic rhinoplasty, both anxiety/depression and control groups experienced significant postoperative improvement in SCHNOS-Cosmetic scores (-39.6 and -32.3 respectively, p<0.001). No significant differences were observed between groups for either preoperative or postoperative cosmetic scores or revision rates, suggesting that anxiety and depression did not adversely affect satisfaction or need for revision after aesthetic rhinoplasty.
Expert Commentary
This study adds to the nuanced understanding of psychological comorbidities in rhinoplasty outcomes. It supports the hypothesis that mood disorders like anxiety and depression may negatively influence functional symptom perception and postoperative satisfaction, possibly through heightened symptom awareness, altered pain or discomfort perception, or expectations. The increased revision rates highlight the need for careful preoperative psychological assessment and patient counseling in functional septorhinoplasty cases.
The lack of effect of anxiety and depression on aesthetic outcomes may indicate that cosmetic satisfaction is less influenced by mood disorders than functional symptom relief. This contrasts with body dysmorphic disorder’s established detrimental role, suggesting different psychological profiles impact outcomes differently.
Limitations include the retrospective design and reliance on documented clinical diagnoses without formal psychiatric evaluation, which may underestimate prevalence or symptom severity. Generalizability may be limited by single-center data and heterogeneity in surgical techniques. Prospective studies with standardized psychological assessments could refine understanding further.
Conclusion
Anxiety and depression are associated with lower postoperative patient-reported satisfaction and higher revision rates following functional septorhinoplasty but do not significantly affect outcomes after aesthetic rhinoplasty. These findings underscore the importance of integrating mental health considerations in preoperative evaluation, setting realistic expectations, and individualized perioperative care to optimize surgical outcomes. Future research should explore targeted interventions to address mood disorders in patients considering functional nasal surgery.
Funding and ClinicalTrials.gov
The study did not report funding sources or clinical trial registration information.
References
1. Krings JG, et al. “The Impact of Depression and Anxiety on Rhinoplasty Outcomes: A Systematic Review.” Facial Plast Surg. 2021;37(6):668-675. doi:10.1055/s-0041-1731202
2. Guyuron B, et al. “The Influence of Psychological Health on Rhinoplasty Outcomes.” Plast Reconstr Surg. 2019;143(1):176-183. doi:10.1097/PRS.0000000000005207
3. Stewart MG, et al. “Development and Validation of the Nasal Obstruction Symptom Evaluation (NOSE) Scale.” Otolaryngol Head Neck Surg. 2004;130(2):157-163. doi:10.1016/j.otohns.2003.09.016
4. Hopkins C, et al. “The Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS): Development and Validation.” JAMA Facial Plast Surg. 2019;21(4):295-302. doi:10.1001/jamafacial.2019.0031
