“The National Health Service is in serious trouble.” This is the opening line of the introduction of Lord Darzi’s report to the Secretary of State for Health in England. His deep dive into the current state of the NHS in the UK includes all aspects of healthcare. One important aspect he picks up on is mental health. This area of patients’ wellbeing has, historically, sometimes been overlooked in favour of dealing with physical ailments. However, since COVID, it is something that has been pushed to the forefront of services that need to be better managed in all healthcare services. Within ENT services, rhinoplasty procedures are often associated with consideration of mental health – specifically patients’ self-image and body dysmorphia. This month’s Editors’ Choice is a Brazilian study which undertook pre and post-procedural questionnaires on patients undergoing open rhinoplasty, aiming to look at their self-image, self-esteem, anxiety and function. Their study raised the question of whether such validated questionnaires should be routinely used to help stratify those who are likely to benefit from these procedures and, likewise, those who are not. After all, the doctrine of do no harm applies to mental health just as much as physical health.
Nazia and Hannah
Body dysmorphia is an acknowledged comorbidity within a subset of rhinoplasty surgery candidates. The nose, being a central feature of the face, has a remarkable impact on an individual’s self-image and confidence. This Brazilian single-centre prospective study followed the journey of 30 female Caucasian subjects who underwent open and structural rhinoplasty, examining self-image, anxiety, self-esteem and functional capacity pre and postoperatively via validated questionnaires (Medical Outcomes Short-Form Health Survey SF-36, Body Dysmorphic Symptoms Scale, Rosenberg Self-Esteem scale, SRQ-20, STAI t/e and Modified YBOCS for Body Dysmorphic Disorder). This study claims to be the first to investigate these different parameters with a variety of questionnaires offering a 360-degree understanding of the impact of open rhinoplasty. After an 18-month follow-up period which coincided with the Covid-19 pandemic, authors concluded improvement in patient self-image, anxiety, self-esteem and mental health post-open rhinoplasty, although improvement in functional capacity based on the SF-36 questionnaire was non-statistically significant. One should, however, note the independent impact of the Covid-19 pandemic on mental health and anxiety of patients, which may have influenced results obtained from this study. Naturally, this study proposes the question – should cut-offs utilising validated questionnaires be routinely used to stratify subjects most likely to benefit holistically from rhinoplasty?
Self-image, self-esteem, anxiety, and functional capacity in patients undergoing open-structure rhinoplasty.
Motoki THC, Silva EN, Isoldi FC, Ferreira LM.
J PLAST RECONSTR AESTHET SURG
2024 [ePub ahead of print].
