One Profile to Rule Them All? A Neural Network Analysis of the Homogenizing Effect of Primary Rhinoplasty.

Background: A goal of aesthetic rhinoplasty is to improve nasal aesthetics while preserving individuality.

Objectives: We hypothesized that primary rhinoplasty has a homogenizing effect on a patient's appearance and in a distinct manner for a given rhinoplasty surgeon.

Methods: Standardized, unedited preoperative and postoperative photographs, including frontal, lateral, and oblique views of 145 Caucasian female primary rhinoplasty patients from the public websites of 3 independent, experienced rhinoplasty surgeons were included (Surgeon A: n = 50, Surgeon B: n = 50, Surgeon C: n = 45). Utilizing Amazon Rekognition, similarities between photographs were calculated by comparing all preoperative photographs to each other and all postoperative photographs to each other. Differences between preoperative and postoperative views were calculated intracohort and intercohort and standardized by the relative change in similarity. Paired t tests evaluated the absolute relative changes, whereas a simple t test assessed the intercohort and intracohort differences.

Results: Patients were significantly more similar postsurgery (17.58%, P < .001) in the lateral (19.17%), oblique (19.02%), and frontal (14.38%) views. In the subgroups, Surgeon A similarity increased 37.50%, Surgeon B had a 24.60% increase, and Surgeon C a 17.68% increase. The intercohort similarity increase (14.15%) was significantly less than the intracohort increase (30.89%).

Conclusions: This study illustrates that primary rhinoplasty patients have increased homogeneity postoperatively, particularly within surgeon cohorts. This is the first study in which the homogenizing effect of rhinoplasties are quantified with neural networks and show the quantifiable "signature" effect of a specific surgeon on their patients' appearances as a population. This study may impact how surgeons set patients' expectations. Level of Evidence: 3 (Therapeutic).