title: Impact of crooked nose rhinoplasty on observer perceptions of attractiveness.
abstract: OBJECTIVE
  To evaluate the impact of a crooked nose on observer perceptions of facial asymmetry and attractiveness and the ability of rhinoplasty to minimize it. We hypothesized that the presence of a crooked nose would penalize symmetry and attractiveness ratings as compared to normal faces. We further hypothesized that straightening rhinoplasty would restore symmetry and improve attractiveness.
  
  
  METHODS
  Randomized controlled experiment.
  
  
  METHODS
  A group of 39 naïve observers viewed pictures of patients with crooked noses before and after straightening rhinoplasty, and normal patients. Observers rated the overall asymmetry and attractiveness, and the asymmetry of facial subunits using a survey with a rating scale of 1 to 10 for each category.
  
  
  RESULTS
  For asymmetry, patient group (preoperative, postoperative, normal) was statistically significant by multivariate analysis of the variance. Post-analysis of variance showed significant differences in asymmetry scores for overall, nose subunit, and mouth subunit. Pairwise testing then showed significantly different overall asymmetry scores between normal and preoperative (P < .001), and preoperative and postoperative (P < .001), but not between normal and postoperative (P = .215) groups. Mixed linear regression analysis showed that decreasing nasal asymmetry by 1 point increases attractiveness by 0.18 points or 0.082 attractiveness standard deviations (P < .001).
  
  
  CONCLUSIONS
  Faces with crooked noses were rated less symmetrical overall and less symmetrical at the nose and mouth subunits as compared to normal and postoperative faces. Straightening rhinoplasty diminished overall facial asymmetry and subunit asymmetry scores. Decreasing nasal asymmetry led to significant improvements in facial attractiveness. These data provide objective evidence supporting the idea that a straightening rhinoplasty can improve attractiveness.
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Roxbury
authors.forename: Masaru
authors.initials: M
authors.lastname: Ishii
authors.forename: Andres
authors.initials: A
authors.lastname: Godoy
authors.forename: Ira
authors.initials: I
authors.lastname: Papel
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Byrne
authors.forename: Kofi D O
authors.initials: KD
authors.lastname: Boahene
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Ishii
mesh_terms: D000328:Adult; D001504:Beauty; D001828:Body Image; D005146:Facial Asymmetry / Q000523:psychology / Q000601:surgery*; D005149:Facial Expression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose; D017060:Patient Satisfaction; D010781:Photography; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods* / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult