Common technical causes of the failed rhinoplasty

Overview

A bad rhinoplasty result can come from the patient's psychology or from abnormal healing, but the authors argue that by far the most common cause is a technical failure by the surgeon. They identify the recurring errors in unsuccessful cosmetic rhinoplasty and explain how mastering fundamentals and sparing tissue prevents most of them.

Sections of note

• Review article; no series or rates are given in the abstract.
• Causes of adverse outcomes listed: psychiatric disturbance, severely aberrant wound healing, and, most commonly, surgeon technical failure.
• A disproportionate number of technical shortcomings stem from errors in basic technique.
• Many remaining errors stem from overaggressive tissue removal.
• Tissue-sparing techniques are recommended to prevent common failures.
• The specific errors are not listed in the abstract.

What it means for a patient

• Most unsatisfactory rhinoplasty results trace to how the operation was done, not to the patient.
• Removing too much cartilage or bone is a leading cause, and it is harder to repair than under-correction.
• The abstract does not give figures on how often each error occurs.

Why this paper matters

The paper, in a Facial Plastic Surgery issue on revision rhinoplasty, argues that revision demand is largely preventable through training and restraint. It reflects the shift from reduction to structure-preserving surgery. No data support the ranking of causes in the abstract.

Terms

• Failed rhinoplasty: a result the patient or surgeon considers unsuccessful, whether cosmetic or functional.
• Technical error: a mistake in surgical planning or execution.
• Tissue-sparing technique: reshaping the nose while preserving cartilage and bone rather than removing it.
• Overresection: removing too much tissue.
• Aberrant wound healing: an unusual scarring response that distorts the result.
• Novice error: a mistake typical of surgeons early in their experience.