Public Awareness, Motivations, and Barriers Toward Rhinoplasty: A Multi-County Cross-Sectional Study Across the Levant

Abstract Background: Rhinoplasty is among the most frequently performed cosmetic surgeries worldwide, yet public awareness, attitudes, and cultural perceptions surrounding it remain underexplored in the Middle East. This study aimed to evaluate public knowledge, motivations, and perceived barriers toward rhinoplasty across five Levantine countries. Methods: A cross-sectional, web-based survey was conducted among adults aged 18 years and older from Palestine, Syria, Iraq, Jordan and Lebanon. A validated, regionally adapted questionnaire assessed sociodemographic characteristics, previous rhinoplasty experience, knowledge and attitude scores, and perceived barriers. Data were analyzed using descriptive statistics, chi-square tests, one-way ANOVA, and binary logistic regression to identify independent predictors of previous rhinoplasty. Results: A total of 4,238 participants were included (mean age 21.8 ± 2.1 years; 68% female). The overall prevalence of prior rhinoplasty was 13.4%, with significant cross-country variation ( p  < 0.001), highest in Iraq (25.7%) and lowest in Palestine (3.7%). The mean knowledge score was 8.15 ± 1.13, differing significantly among countries ( p  < 0.001). Participants rated therapeutic motives significantly higher than cosmetic motives (4.09 ± 0.98 vs. 3.49 ± 1.10; p  < 0.001). Perceived barriers included financial (8.4%), social (11.4%), and combined financial and social factors (15.1%), with notable intercountry differences ( p  < 0.001). Logistic regression identified country of residence, age, and knowledge level as significant predictors of prior rhinoplasty ( p  < 0.001 for all). Conclusion: This multicounty study demonstrates significant sociocultural diversity in rhinoplasty awareness and practice across the Levant. Although general awareness was high, misconceptions persisted, and therapeutic motivations remained predominant. Cultural context, age, and knowledge strongly influenced surgical behavior, while social and financial constraints limited access in more conservative societies. These findings highlight the need for culturally sensitive education, ethical clinical counseling, and regulatory frameworks to ensure safe and informed cosmetic surgery practices in the Middle East.