Gain Scores and Residual Postoperative Burden as Correlates of Patient Satisfaction After Primary Septorhinoplasty

Background and Objectives: Septorhinoplasty aims to improve nasal function and appearance, but change from baseline may not fully reflect the postoperative state perceived by patients. This study compared functional gain, aesthetic gain, and residual postoperative burden in relation to long-term satisfaction after primary septorhinoplasty. Materials and Methods: This retrospective study with cross-sectional long-term assessment included 112 adults who underwent primary open septorhinoplasty (2022–2025) with at least 12 months of follow-up. Nasal obstruction was assessed via Nasal Obstruction Symptom Evaluation (NOSE) and the obstruction domain of the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS-O), cosmetic concerns with SCHNOS-C, and satisfaction with the Rhinoplasty Outcomes Evaluation (ROE). Associations with postoperative ROE scores were examined using correlation analyses and multivariable regression with HC3 robust standard errors. Results: Median NOSE score decreased from 50 to 5 and SCHNOS-C from 28 to 0; median postoperative ROE was 23/24. In the adjusted gain-score model, each 5-point greater SCHNOS-C improvement was associated with a 0.74-point higher ROE score (95% CI, 0.29–1.18; p = 0.001), whereas NOSE improvement was not associated with ROE score (B = 0.03 per 10 points; 95% CI, −0.11 to 0.18; p = 0.649). In the residual-burden model, postoperative NOSE (B = −0.87 per 10 points; 95% CI, −1.26 to −0.48) and SCHNOS-C (B = −3.27 per 5 points; 95% CI, −4.39 to −2.15) scores were independently associated with lower ROE scores (both p < 0.001). Conclusions: Aesthetic improvement and lower residual functional and cosmetic burden were associated with greater postoperative satisfaction. These concurrent associations support assessing postoperative status alongside change scores, with caution regarding restricted score distributions and overlapping patient-reported constructs.