None the less, it remains unclear to what extent the patients benefit psychologically from a rhinoplasty. From this perspective the operation may be seen as a psycho-therapeutic intervention. These positive changes can be attributed to the operation and not to other circumstances as the improvement of self esteem becomes more pronounced with passing time after surgery. Both patients and surgeons expect the improved appearance to foster self esteem, reduce social anxiety, obsessiveness, hostility and paranoia, and thereby improve quality of life, ,, ,. The step of applying for surgery is frequently taken when self-esteem declines with advancing age or when patients take on the role of “highly motivated doers” who simply wish to improve their appearance. Eight out of 10 patients are motivated by their wish for a change or seeing the outcome of successful surgery in others. Dissatisfaction with appearance is most pronounced in rhinoplasty patients compared to candidates for other aesthetic procedures and the mirror daily reminds the patient of the deformity causing distress, mostly since puberty. The mere fact that rhinoplasty patients pay more attention to deformities that may remain unnoticed by peers and would not cause distress in subject not considering a rhinoplasty is a clear indicator of a psychological alteration in the rhinoplasty patient. For patient satisfaction after functional aesthetic rhinoplasty, meeting the aesthetic expectations of the patient was found to be more important than the functional outcome. Patients whose motivation is primarily aesthetic are psychologically more distressed compared to patients whose indication is mainly functional. In addition, psychometric data do not correlate with the degree of deformity. In most patients, the wish to undergo surgery is not related to the objective degree of deformity. We know little about what motivates the patient to accept the inconvenience, risk and financial burden of an operation aimed at aesthetic improvement. Patients who undergo surgery for a functional problem frequently appreciate the aesthetic aspect of the procedure even though the indication is mainly functional. Reports on the use of a drill in 1981 were long forgotten when the development of shavers and endo-nasal drill systems 20 years later brought up the discussion of powered instrumentation for rhinoplasty again, indicating the unresolved issues regarding ideal instrumentation.
At the time, various modifications of osteotomes replaced the hand-held saw for the lateral osteotomy. Many new instruments were introduced between the 1960’s and 1980’s, ,, ,, ,, ,. The first transplantation of costal cartilage was published by Mangoldt in1900. The latter technique is today still named after him. In 1982 Weir described the technique of “nasal infraction”, augmented saddle noses with implants made of duck-sternum and described the rotation of the drooping tip by a wedge excision from the caudal septum. Joseph is generally accepted as the founder of functional rhinoplasty.
It was seven years later that Jacques Joseph published similar techniques, presumably without knowledge of Roe’s reports. Four years later Roe performed endonasal hump reductions. John Orlando Roe entered history as the father of aesthetic rhinoplasty after having reported a “simple operation” in 1887 describing the correction of a “pug nose” through an endonasal approach.
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