Abstract
Self-esteem is one of the most important psychological aspect of cosmetic surgery, in our case aesthetic rhinoplasty surgery. Self-esteem can be described as one’s attitude towards ownself. Our aim is to assess the self-esteem pre-operatively in patients seeking aesthetic rhinoplasty with respect to those seeking functional rhinoplasty and also compare the post-operative improvement in the self-esteem in those patients. This is a Prospective comparative study in a Tertiary care centre. A total of 48 patients who were planned to undergo rhinoplasty over a period of 1 year in a tertiary care centre, A total of 48 patients (24 requiring aesthetic rhinoplasty and the rest functional rhinoplasty),grouped according to their primary objective, were asked to fill up Rosenberg’s self-esteem scale pre-operatively and 6 months post-operatively. Independent t test was used for data analysis. The mean value of self-esteem in aesthetic rhinoplasty group was significantly lower as compared to functional rhinoplasty and there was also significant improvement of self-esteem score post -operatively in the aesthetic rhinoplasty group. Age,gender, marital status, socio-economic status and educational backgrounds were analyzed and there was no significant differences in these factors on comparison between the two groups. Our study showed that self-esteem is an important parameter in cosmetic surgery as patients opting for aesthetic rhinoplasty had lower self-esteem score pre-operatively and there was significant improvement of these scores post-operatively.
Keywords: Cosmetic surgery, Rhinoplasty, Self-esteem, Body dissatisfaction
Introduction
“Beauty lies in the eyes of the beholder” as is said by Margaret Hungerford is a phrase which is admired by all of us and it points to the fact that everyone’s perception of beauty is different. Facial beauty is most important of all among humans. It has been seen that attractive and beautiful faces activate the reward centers in brain [1] and thereby motivate sexual behavior and sex alliances [2]. Hence the concept of beautiful face, the reason for its attractiveness and why people are drawn to beautiful faces has been the point of research among various scientists and philosophers over the ages [3]. Nose being at the center of the face plays a significant role in facial beauty [4]. Hence with the understanding of its importance in contribution to facial beauty among the people, the concept of aesthetic rhinoplasty has gained a new momentum in the past few decades and the number of patients seeking rhinoplasty is on the rise [5].
Rhinoplasty is an operation to change the shape of nose and it aims looks into both maintaining facial aesthetics as well as nasal functions [6]. It can be broadly divided into functional rhinoplasty where the main focus is on improving the nasal airway rather than looking into facial aesthetics and aesthetic rhinoplasty where main aim is to improve the facial aesthetics. Aesthetic rhinoplasty falls under the domain of cosmetic surgery. Patients seeking cosmetic surgery have been seen to suffer from body dissatisfaction [7] as their physical appearance forms an important part of self-esteem. A study by Sarwer et al. showed a significance association between body image and aesthetic surgery [8]. Body image has two parts- body image valence which refers to the importance of body image to self-esteem of the patients and body image value which describes the extent to which one is satisfied by his/hers physical appearance.
Self-esteem is defined as one’s attitude towards one self which may be positive, neutral or negative [9]. It is seen that usually patients seeking aesthetic rhinoplasty has low levels of self-esteem.
Aims and Objectives
To study the socio-economic and demographic profile of the patients seeking rhinoplasty.
To compare the mean score of self-esteem among patients seeking aesthetic rhinoplasty with those who are seeking functional rhinoplasty.
Methodology
A total of 48 patients were included in our study among those who attended our tertiary care center who were planned to undergo rhinoplasty over a period of 1 year by means of systematic random sampling. Out of them 24 patients who needed functional rhinoplasty were divided into one group and the rest were put under aesthetic rhinoplasty group. Patients more than 18 years of age and having deformities of dorsal hump, supra-tip nasal deformity, high septal deviation and dorsal irregularities were included in this study. Patients having congenital anomalies and revision surgery were excluded in our study. Those who wanted rhinoplasty for both functional and aesthetic reason (n = 10) were asked about their main objective and were categorized accordingly.
A pretested and prevalidated questionnaire consisting of information about the patient’s age, gender, marital status, educational background and socio-economic status were asked to fill up by all patients. B J Prasad scale for socioeconomic status was used. Measurement of self-esteem was carried out using Rosenberg self-esteem scale [10]. It consists of 10 items and each point is scored ranging from 1 to 4. Response options range from “strongly disagree” to “strongly agree” and were coded from 1 to 4. Maximum score 40 and minimum score 10 and score below 21 indicate low self-esteem [11]. Higher scores correspond to high self-esteem.
All patients belonging to both groups were asked to fill both of these prior to surgery. Informed consent regarding surgery was also taken. Following surgery these patients were followed up regularly and they were asked to fill up the Rosenberg self-esteem scale at 6 months post operatively.
Statistical Analysis
Data entry and analysis were done in blinded fashion. Independent t-test was performed to assess statistical significance and p value < 0.05 was considered statistically significant. Levene’s test was also performed to assess the equality of variances. Statistical analysis was completed using SPSS Version 27(SPSS Inc., Chicago, IL). Data were expressed in tables.
Results
Twenty four patients were under aesthetic rhinoplasty group and 24 under functional rhinoplasty group. Mean age in the functional rhinoplasty group was 28.68 and that of aesthetic rhinoplasty group was 25.57. No significant difference was noted. Table 1 shows among the 24 patients in aesthetic rhinoplasty group 15 were female and 9 were male where as in the functional group 13 female and 11 male patients were present. (Table 1).
Table 1.
Distribution of sex in both groups
| Gender | Functional rhinoplasty patients (n = 24) | Aesthetic rhinoplasty patients(n = 24) |
|---|---|---|
| Male | 11(45.83%) | 9(37.5%) |
| Female | 13(54.16%) | 15(62.5%) |
Table 2 shows that majority of the patients seeking both aesthetic as well as functional rhinoplasty belonged to upper middle, middle and lower middle class though the values were not statistically significant (Table 2).
Table 2.
Distribution of the patients according to their socio-economic status
| Socio-economic status | Functional rhinoplasty patients (n = 24) | Aesthetic rhinoplasty patients(n = 24) |
|---|---|---|
| Upper class | 5 | 3 |
| Upper middle class | 6 | 7 |
| Middle class | 6 | 9 |
| Lower middle class | 5 | 4 |
| Lower class | 2 | 1 |
Tables 3 and 4 shows that majority of the patients seeking rhinoplasty were unmarried or single and had medium educational level though it bears no statistical significance (Tables 3 and 4).
Table 3.
Distribution of the patients with respect to marital status
| Marital status | Functional rhinoplasty(n = 24) | Aesthetic rhinoplasty(n = 24) |
|---|---|---|
| Single | 12 | 13 |
| Married | 9 | 10 |
| Separated | 3 | 1 |
Table 4.
Distribution of the patients with respect to education level
| Education level | Functional rhinoplasty(n = 24) | Aesthetic rhinoplasty(n = 24) |
|---|---|---|
| Low | 8 | 7 |
| Medium | 11 | 14 |
| High | 5 | 3 |
Thus we saw that age, sex, socio-economic status, marital status and educational backgrounds had no significant differences among the two groups (p value > 0.05). Levene’s test for equality of variances was also not significant (p > 0.05).
Using the t-test for independent groups it was seen that the mean self-esteem score in the aesthetic surgery group was significantly lower than that of the functional rhinoplasty group as shown in Table 5.
Table 5.
Mean self-esteem value in both groups with statistical analysis
| Group | Mean | t test statistic | p value |
|---|---|---|---|
| Aesthetic rhinoplasty patients | 25.04 | 6.83 | < 0.05 |
| Functional rhinoplasty patients | 28.89 |
Table 6 shows that in 6 months most operatively there was an increase in self-esteem score in both the groups but increase was statistically significant in patients who have undergone aesthetic rhinoplasty than in those patients who have undergone functional rhinoplasty (Table 6).
Table 6.
Comparison between mean pre and post operative self-esteem score
| Group | Pre-operative mean score | Post operative mean score | p value |
|---|---|---|---|
| Aesthetic rhinoplasty group | 25.04 | 28.66 | < 0.05 |
| Functional rhinoplasty group | 28.89 | 29.12 | > 0.05 |
Discussion
Rhinoplasty falls under that segment of cosmetic surgery which deals with the face its beautification, hence majority of patients seeking rhinoplasty suffer from low self-esteem or those who are dissatisfied with their body image and even many may be suffering from depression also. A study by Naraghi M [12] suggests that depression is seen in patients wanting aesthetic rhinoplasty commonly. In our study we have also seen statistically significant difference in self-esteem score among patients who were planned for aesthetic rhinoplasty, these patients had a low mean score as compared to those who wanted rhinoplasty mainly for other nasal problems rather than aesthetic reasons. Results of our studies are also consistent with studies by Phillips et al. [13] which showed that there were low values of self-esteem and body image measures in patients wanting aesthetic rhinoplasty.
In our study we have seen that women are mostly interested in aesthetic surgery and incidence is much more among unmarried women as compared to married women. Studies by Cash TF [14] and Wildgoose P [15] corroborate this observation. Most of these patients in our study belonged to the middle class, upper midlle or lower middle class. Incidence of patients seeking rhinoplasty from upper class was very less most probably because of the fact that our study was conducted in a government hospital which these people less attend. Also lower class patients were also less most probably due to lack of awareness. Both the groups were assessed with respect to age, gender, SES, marital status and educational qualification but no significant differences could be not found.
In our study we have seen that there was a significant increase in self-esteem score post operatively in the aesthetic rhinoplasty group during follow up at 6 months. A study by Moss et al. [16] evaluated the long term effect of cosmetic surgeries and have concluded that aesthetic surgery can improve depression, self-esteem and anxiety. Our study is also consistent with the findings of the studies by Von Soest et al. [17] which showed increase self-esteem following aesthetic surgery. Studies have also shown that other psychological variables like depression and anxiety showed improvement following aesthetic surgery [18]. Our study also backs the notion that aesthetic rhinoplasty is associated with a negative body image and low self-esteem as shown by studies by Atari M and Naraghi M [19].
There were certain limitations in our study the scale we have used to measure self-esteem could have been more comprehensive by including more aspects of self-esteem. We should have used various psychometric instruments by more acute sampling methods under guidance of psychologists.
Conclusion
Thus we see that psychological evaluation is very much necessary in patients undergoing aesthetic surgery as it is very much necessary for the surgeons to detect psychologically problematic patients to give the best possible outcome to the patients. It is better to take assistance of psychologists to use various psychometric instruments for assessment of patients. A cosmetic surgeon should be aware of the psychology of cosmetic surgery and related disorders.
Funding
None.
Data Availability
Present.
Code Availability
Present.
Declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Human and Animal Rights
Research involving human participants only no animals were used by us for this study.
Ethical Approval
Taken.
Consent to Participate
Taken from all the patients.
Consent for Publication
Taken from all the authors.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Subhadeep Chowdhury, Email: suvachowdhury4@gmail.com.
Sweta Verma, Email: swetavermabgp@gmail.com.
Tithi Debnath, Email: tithi_debnath@rediffmail.com.
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Data Availability Statement
Present.
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