Assessment of Postoperative Satisfaction in Patients Following Rhinoplasty: A Cross-sectional Study

Abstract

Background:

Rhinoplasty, a common cosmetic procedure, involves reshaping the nose; the procedure can improve birth defects, airway functionality, and facial appearance. This study aimed to investigate the aesthetic and functional outcomes with the role of patient demographics on outcomes among Saudi patients after rhinoplasty. It also explored the effect of social media on decision-making and the level of satisfaction following rhinoplasty.

Methods:

This retrospective cross-sectional study was conducted between 2023 and 2024 in Saudi Arabia on 54 patients (12 men and 42 women) aged 16–35 years who underwent rhinoplasty. The patients’ aesthetic and functional satisfaction outcomes were assessed using an online rhinoplasty outcome evaluation (ROE) questionnaire.

Results:

The mean ROE satisfaction score after rhinoplasty was 59.49 ± 19.85. More than one-half of the participants (n = 37) scored more than 50%. Based on the ROE and demographic characteristics, there were no significant differences in ROE satisfaction scores among sex (P = 0.21), age (P = 0.26), education (P = 0.45), income (P = 0.11), and marital status (P = 0.76) except occupation category (P = 0.009). Furthermore, in 58% of participants, the Nasal Obstruction Symptom Evaluation scale showed no significant problems after rhinoplasty.

Conclusions:

A considerable proportion of patients were satisfied with the aesthetic and functional outcomes after rhinoplasty. The study also found encouraging results on the effect of social media on satisfaction levels. The findings of this study show that rhinoplasty can lead to aesthetically pleasing outcomes in a diverse population, such as in Saudi Arabia.

Takeaways

Question: What are the aesthetic and functional outcomes of rhinoplasty, and what is the impact of social media on decision-making for patients undergoing rhinoplasty in the Kingdom of Saudi Arabia?

Findings: This retrospective cross-sectional study indicates that a significant number (59%) of patients were satisfied with the aesthetic and functional outcomes after rhinoplasty. The study also found encouraging results regarding the impact of social media on patients’ satisfaction levels.

Meaning: This study shows that rhinoplasty can lead to aesthetically pleasing outcomes in a diverse population such as Saudi Arabia. Future research with a larger sample size is suggested.

INTRODUCTION

Rhinoplasty is one of the most common cosmetic surgical procedures performed worldwide,¹ which involves changing the shape and size of the nose.² The nose is a distinctive facial feature of great aesthetic importance. People with nasal abnormalities can feel unconfident about their appearance, which might lead to several psychological outcomes.³

In rhinoplasty, the assessment of the surgical outcome, evaluated by patient satisfaction or quality of life, is essential.⁴ The goal of rhinoplasty is to satisfy patients with postoperative aesthetic and functional outcomes.⁵ Patients’ satisfaction varies significantly based on sex, age, education level, ethnicity, culture, and expectation level.⁶ To improve nasal appearance and function, multifaceted and specialized surgical procedures have been considered, including different types of rhinoplasties.⁷

Several questionnaires have been used as tools to evaluate satisfaction outcomes after rhinoplasty.⁸ The rhinoplasty outcome evaluation (ROE) is one of the useful questionnaires and is commonly used for evaluating outcomes of cosmetic rhinoplasty.⁹

Moreover, very limited research sufficiently defines how patient characteristics affect advancements in patient-reported satisfaction and quality of life, and the few existing studies present contradictory findings.¹⁰ Although various earlier studies focused on surgical procedures, postoperative complications, and rhinoplasty materials, very few scholars have paid attention to the assessment of outcomes after rhinoplasty. In the Kingdom of Saudi Arabia, rhinoplasty has been performed as the most common aesthetic procedure.^11,12

There is a lack of knowledge regarding the impact of social media on satisfaction levels after rhinoplasty. Very few studies on rhinoplasty, including prevalence, function, cosmetic causes, and the possible associated factors,¹³ research trends,¹¹ and demographic characteristics¹⁴ have been conducted in Saudi Arabia. However, to the best of our knowledge, postoperative satisfaction after rhinoplasty has never been studied in Saudi Arabia. Therefore, this study represents the first attempt to analyze satisfaction outcomes using the ROE questionnaire after rhinoplasty in Saudi patients. The study also aimed to identify the factors that affect patient satisfaction and the association of the ROE scores with Nasal Obstruction Symptom Evaluation (NOSE) scores, as well as the effect of social media, to further recognize the determinants of postoperative satisfaction.

METHODS

Study Design and Sampling

This retrospective cross-sectional study was conducted online in Saudi Arabia from December 2023 to October 2024. The ROE questionnaire¹⁵ and NOSE questionnaire¹⁶ were administered at least 6 months postoperatively to residents of Saudi Arabia via a web link through various social media platforms such as WhatsApp, Messenger, and X (formerly Twitter). The survey link was also disseminated through email, ensuring diverse and widespread outreach across various digital communication channels.

Inclusion Criteria

The inclusion criteria consisted of adult men and women aged between 16 and 35 years who underwent rhinoplasty at government-controlled Saudi hospitals within the last 5 years (2020–2024).

Exclusion Criteria

The exclusion criteria included subjects with additional sinonasal pathology (such as nasal polyposis) and those who underwent rhinoplasty in private hospitals or centers.

ROE Questionnaire

The ROE is a validated questionnaire developed to assess patient satisfaction and the final results of rhinoplasty.^15,17 It is primarily used to evaluate the effects of aesthetic aspects on quality of life, in addition to functional outcomes. It comprises 6 questions: 5 about nose shape and 1 about nasal breathing. Each question is scored from 0 to 4, where 0 represents the most negative answer and 4 represents the most positive answer. The sum of the score is divided by 24 and multiplied by 100 to obtain a score ranging from 0 to 100. A lower score indicates lower satisfaction levels.

Nasal Obstruction Symptom Evaluation

The NOSE questionnaire is a validated tool¹⁶ consisting of 5 simple questions that can help us understand how airway functionality can affect quality of life. A score of 0 indicates no problems with nasal obstruction, whereas a score of 100 indicates the worst possible problems with nasal obstruction.¹⁸ Furthermore, other questions explored the effect of social media on the process of deciding to undergo rhinoplasty.

Ethical Consideration

The present study was approved by the institutional review board of the ethical committee of King Saud University, Riyadh, Saudi Arabia, in accordance with the Declaration of Helsinki. Informed consent was obtained from all study participants before the commencement of the ROE questionnaire. All participants were introduced to the rationale of the study before filling out the ROE questionnaire and were informed that participation was voluntary and that the data, recorded anonymously, would remain confidential and used for research purposes only.

Statistical Analysis

Statistical analysis was performed using IBM SPSS Statistics 29.0.0.0. Mean, SD, and range were used to describe quantitative variables, whereas frequency and percentage were used for qualitative variables. The χ² test was used to compare qualitative variables between groups. The Student t test for independent samples was used to compare normally distributed quantitative variables between 2 groups. For comparing quantitative variables between more than 2 groups, the analysis of variance test was used. In cases where the variables are not normally distributed, the Mann-Whitney U and Kruskal–Wallis tests were used instead. A P value of less than 0.05 was considered statistically significant.

RESULTS

Sociodemographic Characteristics of Study Participants

Demographic characteristics with ROE satisfaction scores of 54 patients (n = 54) were included in the final analysis and are shown in Supplemental Digital Content 1. (See Supplemental Digital Content 1, which provided sociodemographic data with the ROE satisfaction score of the participants, https://links.lww.com/PRSGO/E415.) The sample comprised 42 female (77.8%) and 12 male (22.2%) patients. The population was divided into 3 groups: less than 18, 18–24, and 25–35 years, with the largest proportion (n = 24, 44.4%) aged 18–24 years. More than half of the participants (n = 30, 55.6%) had bachelor’s degrees and were employed (n = 36, 66.7%). The majority of participants had an income higher than 20,000 SR (n = 19, 35.2%). Participants from the central region of Saudi Arabia represented 51.9% (n = 28) of the total sample, whereas single participants represented 55.6% (n = 30), followed by married ones (n = 19, 35.2%).

Based on the satisfaction ROE scale, the mean ± SD score was 59.49 ± 19.85. More than half of the participants (n = 37, 68.5%) were classified as being in the high satisfaction group (ROE score > 50), whereas 17 participants (31.5%) were in the low satisfaction group (ROE score ≤ 50).

The results show that there were no significant differences in mean ROE satisfaction scores based on age (P = 0.26), sex (P = 0.21), education (P = 0.45), income (P = 0.11), and marital status (P = 0.76). However, the mean satisfaction scores significantly differed by the occupation category (P = 0.009).

The NOSE

The NOSE among the participants was done through the questions and answers presented in Table 1. The largest proportion of the participants (59%) reported that all the investigated symptoms show no problems, including nasal congestion or stiffness, nasal blockage, trouble breathing through the nose, trouble sleeping, and being unable to get enough air through the nose during exercise.

Table 1.

The NOSE

Nasal Obstruction Symptoms	Not a Problem		Mild Problem		Moderate Problem		Fairly Bad Problem		Severe Problem
	n	%	n	%	n	%	n	%	n	%
Nasal congestion or stuffiness	32	59.3	8	14.8	12	22.2	2	3.7	0	0.0
Nasal blockage or obstruction	32	59.3	8	14.8	10	18.5	3	5.6	1	1.9
Trouble breathing through your nose	33	61.1	5	9.3	10	18.5	5	9.3	1	1.9
Trouble sleeping	31	57.4	10	18.5	10	18.5	2	3.7	1	1.9
Unable to get enough air through your nose during exercise or exertion	31	57.4	12	22.2	7	13.0	4	7.4	0	0.0

The overall level of obstruction based on the ROE scale and the relation with the NOSE scale is shown in Table 2. The largest proportion of the participants (n = 25; 46.3%) had mild obstruction, followed by those with no obstruction (n = 15; 27.8%), then moderate obstruction (n = 9; 16.7%), and finally severe obstruction (n = 5; 9.3%). There was no significant correlation (P = 0.3) between obstruction and satisfaction scales.

Table 2.

The Relation Between ROE and NOSE Scales

ROE Score	No Obstruction		Mild		Moderate		Severe		P
	n	%	n	%	n	%	n	%
≤50% (n = 17)	4	23.5	6	35.3	4	23.5	3	17.6	0.33
>50% (n = 37)	11	29.7	19	51.3	5	13.5	2	5.4
Total: n = 54	15	27.3	25	46.3	9	16.7	5	9.3

Supplemental Digital Content 2 shows that rhinoplasty information among the candidates revealed that the major reason for undergoing rhinoplasty was aesthetic (75.9%), and the majority (n = 47) of the participants performed it only once (87%). (See Supplemental Digital Content 2, which demonstrates the role of social media and reasons for the decision to undergo rhinoplasty, https://links.lww.com/PRSGO/E416.) The ROE satisfaction scores according to the reasons for undergoing rhinoplasty shared on social media were as follows: aesthetic (56.5 ± 17.43), functional (65.97 ± 22.27), and a combination of aesthetic and functional (71.42 ± 27.7).

The role of social media in the decision to undergo rhinoplasty is also illustrated (Supplemental Digital Content 2, which demonstrates the role of social media and reasons for the decision to undergo rhinoplasty, https://links.lww.com/PRSGO/E416). Twenty-eight (51.9%) participants reported spending 4–6 hours daily on social media applications. The most reported applications were Snapchat, WhatsApp, TikTok, and X (Twitter). Cosmetic science and fashion were the major content categories watched as reported by the participants. The majority of the candidates (85.2%) reported that they desired to undergo rhinoplasty, and 72.2% of the participants reported that the results of rhinoplasty matched their expectations based on the pictures they had seen. Most of the participants (75.9%) reported that their desire to undergo rhinoplasty was influenced by celebrities.

The relationship between satisfaction score and social media role is also presented in Supplemental Digital Content 2 (https://links.lww.com/PRSGO/E416). The mean satisfaction score showed no significant association with the impact of viewing before-and-after rhinoplasty images on social media (P = 0.3). Likewise, it was not significantly correlated with the expectations formed based on those images (P = 0.4). However, a significant relationship was observed between the mean satisfaction score and the influence of celebrities (P = 0.007), with higher satisfaction reported among individuals who were not influenced by celebrities to undergo rhinoplasty.

DISCUSSION

Rhinoplasty is one of the most common plastic surgical procedures that has been developed worldwide in the last decade.² It is performed for the improvement of aesthetic and functional outcomes in patients.¹⁹ Besides an objective assessment of the technical success of rhinoplasty, subjective satisfaction based on patients’ expectations, psychosocial factors, and perceived change is a very important condition of success.

Rhinoplasty is the only procedure used to correct birth deformities, improve breathing problems, or repair flaws caused by an injury.²⁰ In contrast, other possible reasons to undergo this procedure include increased self-awareness, social media influence, and the progression of surgical procedures in the last 2 decades.⁶

Several factors, including sex, age, social media, patients’ expectations, level of education, and airway functionality, can affect the satisfaction level and play a key role in assessing the satisfaction level after surgery.¹⁶ Due to its aesthetic nature and significant influence on the self-image and self-confidence of the patient, the analysis of the final rhinoplasty results should be made from the patient’s viewpoint²¹

The surgeons also play a critical role in rhinoplasty, affecting aesthetic and functional outcomes. Their training, meticulous planning, and excellent surgical skills directly affect the safety, outcome, and satisfaction of the patient. Poorly performed rhinoplasty can lead to deformities and breathing issues. Specific surgical techniques and approaches (open and closed approaches)²¹ have been used by surgeons to correct deformities of the nasal anatomy in rhinoplasty. Previous studies using a wide range of study designs and validated ROE to assess the aesthetic features of rhinoplasty observed a beneficial effect on satisfaction and quality of life.^9,22

A substantial number of publications on rhinoplasty have appeared in Saudi Arabia, which mainly assessed research output¹¹ and demographic characteristics of Saudi patients¹⁴ and explored the prevalence, function, cosmetic causes, and possible associated factors of rhinoplasty.¹³ Several other studies with ROE satisfaction outcomes in postrhinoplasty patients have been reported worldwide, indicating that patient satisfaction is significantly high.²³ Swami²⁴ has investigated the factors affecting satisfaction with rhinoplasty.

Numerous previous studies examined the pre- and postoperative rhinoplasty satisfaction scores in 2 age groups and found inconsistent results.²⁵ Furthermore, contradictions have been reported regarding the effect of sex on the level of satisfaction after rhinoplasty surgery.^4,6,26

Functional rhinoplasty aims to improve and support the mechanical components of the nose, resulting in a better-functioning nose.²⁶ Various previous studies have revealed that subjects who have undergone rhinoplasty have shown improvement in airway functionality and related symptoms, and this enhancement has a significant influence on their satisfaction outcomes.^16,26,27 Higher satisfaction rates after rhinoplasty using an online social media website have been reported.^28–30 However, results by Khansa et al²⁸ revealed that men had lower satisfaction with rhinoplasty, and the reasons for their dissatisfaction were not as clear as for women. Furthermore, an Egyptian study by Foda³¹ reported higher satisfaction rates among Arabian patients after external rhinoplasty.

The nose, being the most prominent part of the face, plays a vital role in physiological, aesthetic, and psychosocial functions.³² Cosmetic surgery usually assesses results from the patient’s viewpoint because many fundamental items, such as appearance and function, are best evaluated by the patient’s self-assessment. However, different factors such as sex, the perception of the patient,³³ preoperative nose shape,³⁴ nasal breathing function, and the psychology of the patients³⁵ contribute to patient satisfaction and the successful outcome of rhinoplasty. However, low satisfaction rates remain frequent in rhinoplasty due to the difficulty of the procedure, in addition to unrealistic patient expectations.²⁸

The present study was designed to investigate demographic, aesthetic, and social media factors that contribute to satisfaction with rhinoplasty outcomes in Saudi patients using an online ROE questionnaire.⁶ Most participants in this study were young adults, between the ages of 18 and 24 years, were women, and mostly had a bachelor’s degree. A considerable number were employed, with incomes mostly exceeding 20,000 SR. Notably, participants were mostly from the central regions of Saudi Arabia. These demographic trends indicate that young, educated women are more likely to seek cosmetic surgery, often driven by sociocultural pressures and personal aesthetic goals.³⁶ There is a large difference between the number of men (n = 12, 22%) and women (n = 42, 78%) involved in this study. These results may be attributed to the fact that women are more sensitive than men and are concerned about their physical appearance. Most of the subjects in our study were single. Overall, in most previous studies, the number of single people was higher than that³⁷ of married people.^21,37

The mean score of satisfaction on the ROE scale was 59.49 ± 19.85, with more than half of the patients having a score exceeding 50%, which agrees with the postoperative satisfaction rate reported between 54.3% and 88.7% in various studies.³⁸ This generally reflects positive perceptions in this sample about the outcomes of rhinoplasty.

In this study, we attempted to investigate the relationship between patients’ age, sex, educational level, occupation, monthly income, and marital status with patients’ satisfaction ROE score. However, these values were statistically nonsignificant (P ≥ 0.05) except for occupation status (P = 0.009). The lack of statistical significance may be due to the relatively small sample size or a population less influenced by traditional demographic variables. However, these findings contradict several previous studies.^25,28

Our study showed that unemployed patients had much higher satisfaction scores compared with employed patients and students (P < 0.009). However, this result is inconsistent with a previous study,¹⁰ where unemployed patients unemployed had the lowest satisfaction scores compared with others. In this study, the satisfaction rate in women was higher than in men, but this difference was not significant, possibly due to the small sample size or the low number of men in this study. However, this study is in line with the results of a previous study in which the ROE score did not show a significant difference between men and women.³⁹

The primary inspiration for rhinoplasty was aesthetic enhancement, reported by 75.9% of participants. This highlights the key role of appearance in the decision to undergo the procedure. Most participants underwent rhinoplasty only once, indicating satisfaction with initial outcomes or financial and psychological barriers to repeated surgery. The majority of participants achieved ROE satisfaction scores greater than 50%, suggesting generally positive outcomes. This corroborates previous research²⁵,³⁹ demonstrating high satisfaction rates with aesthetic procedures, although the wide SD suggests variability in individual experiences.

Nasal function is an important outcome in rhinoplasty and can negatively impact quality of life. The need to improve nasal function and aesthetics is becoming increasingly important due to greater social interaction, widespread use of social media, and the growing emphasis on achieving an ideal appearance.⁴⁰ Interestingly, nasal obstruction symptoms were generally not reported as problematic by most participants, with more than half reporting no significant issues such as nasal congestion, blockage, or breathing difficulties. The NOSE scale revealed that the majority had mild or no obstruction, with only 9.3% experiencing severe obstruction. This indicates that functional concerns were secondary motivations for the procedure. Additionally, the lack of a significant correlation between obstruction and satisfaction (P = 0.3) suggests that aesthetic outcomes, rather than functional improvements, primarily drive satisfaction. This level of satisfaction with the shape of the nose among patients who participated in our study may be attributed to cultural and societal factors. In the Saudi Arabian culture, a strong emphasis is placed on physical appearance, and the nose is often considered a defining feature of one’s appearance. Additionally, traditional beauty standards in Saudi Arabia may also place a greater emphasis on the shape of the nose.⁴¹

Additionally, social media played a pivotal role in influencing rhinoplasty decisions. Social media and the widespread access to images of people from all around the world have increased exposure to different facial features and have led to the development of similar aesthetic preferences. One of the interesting features of this study was the investigation of how social media affects rhinoplasty satisfaction. Our results showed that patients who were influenced by celebrities to undergo rhinoplasty had lower satisfaction scores compared with others. This is according to a previous study that showed that patients who were influenced by social media had a lower satisfaction score.⁴²

Furthermore, patients’ satisfaction results, divided into high satisfaction (ROE score > 50) and low satisfaction (ROE score ≤ 50) groups, were not discussed in detail here. Although this categorization provides an overview, it may not cover the full spectrum of patient satisfaction. We suggest that future studies may use more sensitive patient-reported outcome measures with 2 or more categories to more accurately capture individual perspectives.

We hope our work can provide new knowledge and share research data in the field of rhinoplasty. This ultimately leads to providing more realistic expectations and greater patient-reported satisfaction and quality of life. Moreover, the findings of the present study help surgeons predict patients’ satisfaction after rhinoplasty. Future prospective, randomized studies with larger sample sizes should be undertaken to investigate which factors determine the variance in patient-reported satisfaction after rhinoplasty and to understand how much impact these factors have on this variance.

Limitations

This study has several limitations. First, the small sample size and the low response rate from participants were due to the voluntary nature of completing the ROE questionnaire. In addition, the low number of male participants was one of the limiting factors in this study. The second limitation was the lack of a preoperative evaluation, and the third limitation was reliance on a self-reported questionnaire instead of clinician-administered evaluation measures. Finally, parameters such as the type of nose deformity and pre-rhinoplasty psychosocial well-being were not investigated, although these would provide more accurate information on satisfaction factors.

Moreover, this study does not take the surgical procedure (open/closed), duration of the nasal package, or postoperative complications into account. These represent important parameters in postoperative evaluation after rhinoplasty. We acknowledge that omitting these variables may limit the depth of the analysis. Future studies should incorporate these parameters to provide a more comprehensive evaluation of outcomes.

CONCLUSIONS

A considerable proportion of patients were satisfied with the aesthetic and functional outcomes after rhinoplasty. There were no statistically significant differences between ROE satisfaction scores and demographic characteristics, except for occupation. Furthermore, the majority of participants showed no significant problems on the NOSE scale after rhinoplasty. This study also found significant results regarding the effect of social media on satisfaction levels. We conclude that rhinoplasty, although a complex procedure, can lead to aesthetically pleasing outcomes in a diverse population, such as in Saudi Arabia.

DISCLOSURES

The authors have no financial interest to declare in relation to the content of this article.

ACKNOWLEDGMENTS

The authors thank the King Saud University, Riyadh, Kingdom of Saudi Arabia, for their on going funding program (ORF-Ctr-2025-10) and financial support. They are also very grateful to the participants for their cooperation in the study.