An anatomic basis for revision rhinoplasty

Overview

As rhinoplasty has become more popular, expectations of patients and surgeons have risen, and revision surgery has become a field of its own. The authors set out the two foundations of a revision: understanding what the patient is unhappy about, and understanding the anatomic causes behind the failed result.

Sections of note

• Review article; no patient data, techniques or outcomes are described in the abstract.
• Revision rhinoplasty is described as an evolving field with unique challenges.
• First step: address the patient's specific concerns and emotional issues.
• Second step: thoroughly analyze and understand the anatomic causes that led to the need for revision.
• The abstract does not list the anatomic causes covered.

What it means for a patient

• A good revision consultation begins with what bothers you and why, then a detailed examination of the structures under the skin.
• The surgeon needs to work out what was removed, moved or weakened in the first operation before planning the fix.
• This is a framework article, without evidence on outcomes.

Why this paper matters

The paper opens a Facial Plastic Surgery issue on revision rhinoplasty and sets out the diagnostic approach that the more technical articles build on. It does not report how often each anatomic cause is found or how analysis changes outcomes.

Terms

• Revision rhinoplasty: a repeat operation on a nose that has already had surgery.
• Anatomic analysis: systematic examination of the nasal bones, cartilages, septum and skin to find the cause of a deformity.
• Failed rhinoplasty: a result the patient or surgeon considers unsuccessful.
• Nasal framework: the bone and cartilage skeleton that gives the nose its shape.
• Patient expectations: what the patient believes surgery will achieve.