1.Name

2.NASAL OBSTRUCTION SYMPTOM EVALUATION (NOSE) Score

Over the past 1 month, how much of a problem were the following conditions for you?

No problem

Mild

Moderate

Severe

Very severe

Nasal congestion or stuffiness ('snotty')

Nasal blockage or obstruction

Trouble breathing through my nose

Trouble sleeping

Unable to get enough air through my nose during exercise

3.Rhinoplasty Outcome Evaluation (ROE) Part 1

Absolutely not

A little

More or less

A lot

Absolutely yes

Do you like the appearance of your nose?

Do you breathe well through you nose?

Do you think that your friends and people dear to you like your
nose?

Do you think that the current appearance of your nose hinders your
social or professional activities?

Do you think that the appearance of your nose is the best that it
could be?

4.Rhinoplasty Outcome Evaluation (ROE) Part 2

Sure I would

Probably yes

Possibly yes

Possibly no

Certainly no

Would you have surgery (or repeat surgery) to alter the appearance of your nose or to improve your breathing?

5.FACE-QTM - SATISFACTION WITH OUTCOME

Definitely
disagree

Somewhat
disagree

Somewhat
agree

Definitely
agree

I am pleased with the result.

The result turned out great.

The result was just as I expected.

I am surprised at how good I look in the
mirror.

The result is fantastic.

The result is miraculous.