Gender-affirming rhinoplasty - critical analysis of outcomes using the standardized cosmesis and health nasal outcomes survey (SCHNOS)

Abstract

Aim: Gender-affirming rhinoplasty is a key component of facial gender-affirming surgery, aiming to align nasal aesthetics and function with a patient’s gender identity. While there has been a strong emphasis on the cosmetic outcomes of this procedure, rhinoplasty is also intended to improve nasal function. Few studies have assessed functional outcomes in this population using validated, patient-reported measures. This study aims to evaluate changes in nasal function and cosmetic satisfaction using the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) in patients undergoing gender-affirming rhinoplasty.

Methods: A retrospective cohort of 20 patients (all facial feminization) who underwent gender-affirming rhinoplasty at a tertiary academic center was analyzed. SCHNOS-Obstruction (SCHNOS-O) and SCHNOS-Cosmesis (SCHNOS-C) scores were collected preoperatively and at approximately 3, 6, and 12 months postoperatively. Paired t-tests or Wilcoxon signed rank tests were used to compare pre- and postoperative scores, with subgroup analyses performed using analysis of variance. Statistical significance was set at P < 0.05.

Results: Statistically significant and clinically meaningful improvements in SCHNOS-C scores were observed at 3, 6, and 12 months post-operatively, compared to pre-operatively (P < 0.05). Among the subgroup of patients with baseline nasal obstruction, a statistically and clinically significant reduction in score was seen at 6 months post-operatively compared to baseline (P < 0.05). Patients without nasal obstruction at presentation did not show a worsening SCHNOS-O score at any post-operative timepoint.

Conclusion: Gender-affirming rhinoplasty is associated with significant improvements in aesthetic satisfaction as measured by SCHNOS-C scores, with significant improvements in nasal function seen among those patients with nasal obstruction on presentation. These findings support the use of validated, patient-centered tools in outcome assessment and highlight the need for further research to optimize both functional and cosmetic results in gender-affirming rhinoplasty.

Keywords

Gender-affirming surgery / rhinoplasty / SCHNOS / patient-reported outcomes / transgender health / facial feminization surgery

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