Rhinoplasty Trends and Patient Satisfaction: Analyzing the Less Presence Aesthetic Nose (LPAN) Concept in Japan

PURPOSE: In Japan, a novel rhinoplasty concept known as the less presence aesthetic nose (LPAN) has emerged, emphasizing a subtle and harmonious nasal appearance that avoids creating a strong visual impression. However, LPAN remains loosely defined, leading to discrepancies between surgeons’ interpretations and patient expectations. This study aims to clarify the specific nasal characteristics associated with LPAN, assess patient satisfaction, and underscore the importance of individualized surgical strategies. METHODS: We conducted a retrospective observational study of 102 patients (11 males, 91 females; median age 25.1 years, SD=7.22) who underwent LPAN-centric rhinoplasty by a single surgeon between April 2023 and August 2024. Postoperative data were collected at the three-month follow-up. Cases involving osteotomy were excluded to minimize the impact of residual swelling on measurement accuracy. Intraoperative nasal skin thickness was subjectively graded from “Thick” (5 points) to “Visible Cartilage” (1 point). Standardized preoperative and postoperative (≥3 months) photographs were taken at a fixed distance of 2 feet with a focal length of 50 mm. Four key parameters were measured: (I) Angle D, formed by lines connecting the nasal tip, infratip, and the lowest point of the alar base at a 45° lateral view; (II) N/N ratio, representing nasal tip highlight width relative to maximum alar base width; (III) Alar-Columellar Angle (ACR), measured as the angle between bilateral alar base attachments and the columella; and (IV) NW/ID ratio, indicating maximum alar base width relative to interpupillary distance. Postoperative satisfaction was scored as Great (3 points), Good (2 points), or Poor (1 point). Data were statistically analyzed using paired t-tests, independent t-tests, and one-way ANOVA. RESULTS: At the three-month follow-up, the mean postoperative values were Angle D of 13.1° (SE=0.246), N/N ratio of 44.81% (SE=0.5), ACR of 160.31° (SE=0.097), and NW/ID ratio of 58.22% (SE=0.43). The overall complication rate was low, with one infection and one hematoma resolving without deformity. Primary rhinoplasty cases displayed significantly greater changes in Angle D (p=0.027) and ACR (p=0.044) compared to revision cases. Patients who reported high satisfaction (Great, 67.6%) demonstrated ideal postoperative nasal parameters, with mean values of Angle D=13.17°, N/N ratio=44.3%, ACR=159.69°, and NW/ID ratio=58.82%. These values can serve as objective benchmarks for achieving the LPAN aesthetic. Remarkably, skin thickness was significantly associated with satisfaction (p=0.0078), with slightly thin-skinned patients reporting the highest scores. CONCLUSION: This study establishes objective criteria for LPAN, providing clear benchmarks (Angle D, N/N, ACR, NW/ID) that correlate with patient satisfaction. Patients with slightly thin skin achieved the highest satisfaction, underscoring the importance of considering nasal skin thickness when planning rhinoplasty. By defining the ideal postoperative nasal parameters associated with high satisfaction for LPAN rhinoplasty, this study contributes a valuable framework for achieving consistent, aesthetically pleasing outcomes congruent with patient expectations.