title: The impact of living with a functional and aesthetic nasal deformity after primary rhinoplasty: a utility outcomes score assessment.
abstract: BACKGROUND
  Revision rhinoplasty for functional deformities can be both an aesthetic and reconstructive surgical challenge. We set out to quantify the health state utility assessment of living with the physical appearance of nasal asymmetry along with having nasal obstruction. The use of utility scores has helped to establish the health burden of living with various medical conditions. We sought to quantify living with a health state of nasal asymmetry with nasal obstruction after primary rhinoplasty using utility outcome scores.
  
  
  METHODS
  We used previously validated utility outcome measures to quantify the health burden of this clinical scenario in 128 prospective subjects. These subjects were from a sample of the population and medical students recruited to complete a survey to determine the utility outcome score of revision rhinoplasty using visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG) tests to obtain utility scores for revision rhinoplasty. Linear regression and Student t test were used for statistical analysis.
  
  
  RESULTS
  All measures (VAS, TTO, and SG) for functional nasal deformity (0.80±0.13, 0.90±0.12, and 0.91±0.13, respectively) of the 128 prospective subjects participating in this online study were significantly different (P<0.005) from the corresponding scores for monocular blindness (0.63±0.15, 0.85±0.16, and 0.85±0.19, respectively) and binocular blindness (0.38±0.18, 0.66±0.25, and 0.69±0.24, respectively). Being white was inversely related to the VAS utility scores for rhinoplasty (P<0.05). Additionally, female sex was positively correlated to the TTO score. Age, income, and education were not predictors of utility scores.
  
  
  CONCLUSIONS
  In a sample of the population and medical students, VAS, TTO, and SG utility scores for revision rhinoplasty were determined and can be compared objectively with other health states and diseases with known utility scores. In a preoperative setting, women were objectively willing to potentially "trade" more years of life to treat a functional nasal deformity. If faced with a deformed nose after primary rhinoplasty, our sample population would consent to undergo a revision rhinoplasty procedure with a theoretical 9% chance of mortality and were willing to trade 3.6 years of their remaining life.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Hani
authors.initials: H
authors.lastname: Sinno
authors.forename: Ali
authors.initials: A
authors.lastname: Izadpanah
authors.forename: Stephanie
authors.initials: S
authors.lastname: Thibaudeau
authors.forename: Georges
authors.initials: G
authors.lastname: Christodoulou
authors.forename: Youssef
authors.initials: Y
authors.lastname: Tahiri
authors.forename: Sumner A
authors.initials: SA
authors.lastname: Slavin
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Lin
mesh_terms: D000328:Adult; D001294:Attitude to Health; D017281:Cost of Illness; D004954:Esthetics; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016014:Linear Models; D008297:Male; D015508:Nasal Obstruction / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D009666:Nose / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012086:Reoperation / Q000523:psychology; D012225:Rhinoplasty / Q000523:psychology*; D016896:Treatment Outcome