Aesthetic outcome after nasal reconstruction: patient versus panel perception

Background: Nasal reconstruction after extensive ablative therapy poses a reconstructive challenge. The aim of this study was to assess subjective aesthetic outcome after nasal reconstruction scored by patients and a panel. In addition, inter-rater variability as well as important parameters of good aesthetic outcome were analysed. Methods: A total of 39 consecutive patients treated between November 2001 and May 2005 for (sub) total nasal defects were included. All patients were photographed in a standardised setting. Subjective aesthetic outcome (eight different nasal characteristics on a five-point Likert scale) was assessed by reconstructed patients individually as well. as an independent professional panel consisting of five plastic surgeons. Results: Thirty-three patients (87%) participated in the follow-up study. Questionnaire results demonstrated statistically significant lower panel satisfaction scores (3.5 +/- 0.9) with total nasal appearance than patients (4.2 +/- 1.3; P=0.03). There was a high agreement among panel members as judged by a low inter-rater variability. No relationship between severity of nasal defects and aesthetic outcome was found by patients or professionals. Conclusion: Patient subjective aesthetic outcome was significantly higher than that of a professional panel. Severity of nasal deformity was not an indicator for patient satisfaction. (C) 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.