Nasal Aesthetic Preferences Across Populations: A Systematic Review of Cultural, Ethnic, and Generational Trends.

Nasal aesthetics are central to rhinoplasty outcomes, yet ideals of beauty vary considerably across cultures, ethnicities, and generations. Current evidence is fragmented, often Eurocentric, and lacks a comprehensive synthesis. This systematic review aimed to evaluate nasal aesthetics preferences and their implications for clinical practice. The protocol was prospectively registered on PROSPERO (CRD420251009102). Systematic searches of PubMed, Embase, Web of Science, and PsycINFO were conducted from inception-June 2025. Eligible studies assessed nasal aesthetic preferences in adult (≥18 years) populations. The NOS, NOS-xs, GRADE and AXIS tools were used to guide critical appraisal, and findings were synthesised narratively. 2,881 records were screened, yielding 31 studies with 25,382 respondents. Preferences demonstrated marked regional variation: North American Caucasians favoured a slight dorsal scoop with mild underprojection, whereas East Asian/Middle Eastern groups preferred a straight dorsum with more obtuse nasolabial angles. Chinese cohorts most frequently selected radix positions at the pupil, Japanese studies reported stable nasofacial angles of 30-33°, and Syrian findings converged around ∼31°. Generational trends indicated Millennials and Gen Z favoured longer, straighter noses with augmented radix and reduced rotation. Across populations, overall facial harmony was consistently prioritised over isolated measurements. Notable contradictions (e.g., Alshawaf, 2024 vs. Alharethy, 2017) and the underrepresentation of Black populations highlighted key limitations. Nasal aesthetic preferences are dynamic and context-dependent. Surgeons should adopt a personalised, culturally sensitive approach to rhinoplasty, prioritising timeless harmony over transient fashions. Future research must expand inclusivity, employ standardised measurement tools, and leverage emerging technologies to track evolving ideals and assess psychosocial outcomes.