Facial attractiveness and abnormality of nasal reconstruction patients and controls assessed by laypersons

Background: The goal of nasal reconstruction after a partial or total amputation is to achieve a nasal appearance as natural and normal as possible. It is assumed that laypersons' opinion on facial appearance could affect patient satisfaction or self-concept. The aim of this study was to assess laypersons' opinions on aesthetic outcome of nasal reconstruction. This was compared with the opinion of a professional panel. Second, the effect of informing laypersons about the previous nasal reconstruction of patients on their assessment of facial attractiveness and abnormality was studied. Third, the effects of individual facial features on the assessment of facial attractiveness and abnormality were determined. Methods: A total of 39 consecutive patients treated between November 2001 and May 2005 for (sub) total nasal defects were included, together with a control group of 39 persons without a facial deformity. A group of 20 randomly selected laypersons (10 men and 10 women) assessed facial appearance and abnormality of all 78 persons using standardised colour slides, not knowing who was a patient and who control. Two weeks later they were informed about the true study design and the same questions were asked. In addition, they assessed final treatment results of 39 patients. Results: No differences existed between assessment of aesthetic outcome after nasal reconstruction by laypersons and professionals (54% good to excellent). Patients were perceived significantly less attractive and more abnormal than controls. Prior knowledge had a significant positive effect on mean facial attractiveness and abnormality scores. High positive correlations were found between facial attractiveness and abnormality scores and the frequency of the item 'nothing in particular', meaning if no particular facial feature was judged to be striking, a face was perceived more attractive and less abnormal. Conclusion: Nasal reconstruction patients were perceived significantly less attractive and more abnormal by laypersons than controls. Since faces without striking features were judged to be more attractive, the goal of nasal reconstruction would not only be to create a nose as normal as possible, but also as inconspicuous as possible.

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