The aesthetic nose: do we agree?

The surgeon and patient use the preoperative consultations to develop an agreement regarding the aesthetic goals of a rhinoplasty. This study was designed to evaluate whether people do agree on what makes a nose attractive. Computerized video-imaging technology was used to create nine case studies. The graphics software permitted precise modification to either tip projection, tip rotation, or size of the dorsal hump. Only one parameter was altered in each case. Two hundred fifty judges were asked to identify the most attractive image in each case study. Significant trends were observed in each case, but every image received the preference of some judges. Most judges preferred midrange values in eight of nine cases, but overrotation of the tip was preferred to tip droop, overremoval of the dorsal hump was preferred to underremoval, and overprojection of the tip was preferred to underprojection. The discrepancy in what constitutes an aesthetic nose reinforces the need for the surgeon to clearly understand the patient's specific requests rather than to aim to produce a "standard nose.".