Comprehensive assessment in cosmetic rhinoplasty: The use of the Derriford Appearance Scale for evaluation of patients.

BACKGROUND: Rhinoplasty has a tremendous psychosocial impact. A good surgical correction may not guarantee an expected response from the patient. This is due to the fact that there may be associated psychological distress, the assessment of which may have to be incorporated while evaluating the surgical result. We aimed to identify if the questionnaire may help in identifying patients who might be less satisfied psychologically to the surgical result. This aspect of psychological assessment is not standardized, although it is reported in Western literature and recently in Asian Koreans. Similar studies in an Indian scenario merit deliberation. METHODS: Fifty-one patients who underwent cosmetic rhinoplasty from August 2011 to July 2013 were administered the Derriford Questionnaire preoperatively and postoperatively at 3 months at a mid-zonal hospital. The responses were scored on a five-point Likert scale and analyzed. RESULTS: The overall postoperative score improved from 1.32 ± 0.24 to 1.27 ± 0.24. There was statistically significant improvement in subscales of general, sociosexual, and bodily self-consciousness of appearance. However, the improvement in facial self-consciousness of appearance and negative self-concept was not statistically significant. CONCLUSION: We recommend the use of the Derriford Assessment Scale (DAS) for objective assessment of psychological distress associated with living with a problem of appearance, in addition to assessment of anatomical deformity in patients undergoing cosmetic rhinoplasty. Better preoperative counseling may benefit those with a high score for negative self-concept and facial self-consciousness of appearance.

Pulmonary Embolism in Young Natives of High Altitude.

Thrombotic events are relatively common in high altitude areas and known to occur in young soldiers working at high altitude without usual risk factors associated with thrombosis at sea-level. However, till now, cases with thrombotic events were reported only in lowlanders staying at high altitude. These two cases of pulmonary embolism demonstrate that thrombotic events can occur in highlanders after a prolonged stay at the extreme altitude.