Azabache Protocol®: An Integrated Psychological and Ethical Evaluation Framework for Rhinoplasty Candidates.

[BACKGROUND] Patient dissatisfaction after rhinoplasty is often unrelated to surgical outcomes but rather to unrecognized psychological and ethical variables. Despite advances in technique, instruments, and aesthetic analysis, the emotional dimension of patient selection remains underexplored. The Azabache Protocol® was conceived as an integrated framework for psychological and ethical evaluation prior to rhinoplasty, aiming to improve preoperative decision-making and reduce postoperative conflicts.

[METHODS] Based on more than a decade of clinical observation, the protocol combines emotional typology, subjective evaluation tools, standardized aesthetic and emotional scales, and ethical criteria. It provides surgeons with a structured, surgeon-friendly algorithm to identify risk profiles, guide communication, and support ethical surgical decisions.

[RESULTS] Clinical application of the Azabache Protocol® has demonstrated a decrease in emotional dissatisfaction and postoperative complaints, even in technically successful cases. The framework enhances patient-surgeon understanding and reinforces the ethical dimension of aesthetic surgery by transforming preoperative evaluation into a multidimensional process.

[CONCLUSIONS] The Azabache Protocol® introduces a pragmatic, structured, and ethically grounded approach to psychological assessment in rhinoplasty. By systematizing preoperative emotional analysis, it complements traditional aesthetic planning and contributes to a more responsible, human-centered practice of facial surgery.

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