What motivates secondary rhinoplasty? A study of 150 consecutive patients

Constantian MB.

What this paper says

In 150 consecutive revision rhinoplasty patients averaging 3.6 prior operations, the most common reason for surgery was a new deformity caused by the earlier rhinoplasty (41%), 97% were happy afterward, and the few unhappy patients did not have worse noses than the rest.

Overview

Little is known about why patients seek a repeat rhinoplasty or how satisfied they end up. The author reviewed the charts of 150 consecutive secondary rhinoplasty patients, graded the severity of their deformities, recorded their main motivation, and tallied satisfaction, preoperative depression and postoperative body dysmorphic disorder.

Sections of note

150 consecutive patients (121 women, 29 men), July 2007 to October 2008; deformity graded 1 to 5.
Mean prior operations: 3.6.
Motivations: new deformity after primary rhinoplasty 41%; failure to correct the original problem 33%; intolerable loss of personal, family or ethnic features 15%; further improvement of an acceptable result 10%; airway obstruction 1%.
Patients with new deformities had the most severe preoperative deformities (p < 0.02).
97% happy with their outcomes.
40 patients (27%) depressed before surgery; 3 (2%) showed evidence of body dysmorphic disorder afterward.
Depressed and dysmorphic patients did not have worse deformities than others (p < 0.8695).

What it means for a patient

The worst noses seen in a revision practice were created by earlier surgery, not by nature.
Most revision patients in this series were satisfied, despite an average of more than three previous operations.
Unhappiness after surgery was not explained by how bad the nose was.
One surgeon's chart review with surgeon-recorded satisfaction; no validated questionnaire.

Why this paper matters

It quantifies that iatrogenic deformity drives most revisions and separates the severity of a deformity from the patient's distress. It supports psychological screening before revision. Long-term follow-up and independent outcome measures are not reported.

Terms

Secondary rhinoplasty: a repeat operation on a nose that has already had surgery; also called revision.
Iatrogenic: caused by previous medical or surgical treatment.
Body dysmorphic disorder: preoccupation with a slight or imagined appearance flaw.
Deformity severity grade: the author's 1 to 5 scale for how abnormal the nose was before surgery.
Airway obstruction: blocked nasal breathing.
Consecutive patients: every patient treated in a period, with none left out.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“There is little evidence-based information on secondary rhinoplasty patient motivations for surgery, satisfaction, or revision rates. Methods: The charts of 150 consecutive patients (121 women and 29 men) who underwent secondary rhinoplasty between July of 2007 and October of 2008 were reviewed; preoperative deformity…”

Excerpt; the full abstract is on PubMed.