Intraoperative Patient Photographs as Aesthetic Guidance in Rhinoplasty: Assessing Surgeons’ Reliance on Memory

BACKGROUND: Rhinoplasty is one of the most commonly performed cosmetic surgeries. During rhinoplasty, many surgeons rely primarily on memory and perception from the last preoperative assessment, while others choose to use intraoperative photographic references. Thus, the study aims to evaluate whether it is appropriate to rely solely on memory without visual reference during intraoperative rhinoplasty, or whether the use of intraoperative patient photographs should be recommended. METHODS: A cross-sectional study involving 6 facial plastic surgeons with varying levels of experience. All surgeons completed the Cambridge Face Memory Test (CFMT) before testing to confirm standard facial recognition abilities. Preoperative photographs of 21 rhinoplasty candidates were reviewed, followed by testing performed after a 30-minute interval to simulate intraoperative conditions. Surgeons then identified the original images from modified sets reflecting changes in tip projection, nasolabial angle, nasal dorsum width, and dorsal height. Correlations were made with CFMT scores, age, sex, and years of surgical experience. RESULTS: Surgeons correctly identified the original images in only 25.59% of cases, with significant differences across all parameters (P<0.01). Strong positive correlations were found between CFMT scores and surgeons' age (r=0.68) and experience (r=0.77). Higher CFMT scores and greater experience correlated with improved recall accuracy (r=0.90 and r=0.88, respectively). CONCLUSIONS: This study underscores the limitations of relying solely on memory recall during rhinoplasty and supports the potential role of intraoperative visual references to enhance surgical accuracy. Furthermore, facial recognition abilities in facial plastic surgeons improved with age and surgical experience.