Frequency of the preoperative flaws and commonly required maneuvers to correct them: a guide to reducing the revision rhinoplasty rate

Lee M, Zwiebel S, Guyuron B.

What this paper says

In 100 consecutive revision rhinoplasty patients, 65% complained of a blocked airway, the surgeon found far more deformities than patients reported, and the most common corrective steps were septoplasty (71%), alar rim grafts (67%) and dorsal grafts (63%).

Overview

Knowing what goes wrong after a first rhinoplasty tells surgeons what to prevent. The authors reviewed 100 consecutive patients coming for revision, all operated elsewhere before, recording what the patients complained of, what the senior author (B.G.) found on examination, and which maneuvers were needed.

Sections of note

Retrospective review of 100 consecutive secondary rhinoplasty patients; mean age 39.2; all prior surgery by other surgeons.
Patient complaints: airway occlusion 65%, dorsal asymmetry 33%, nostril asymmetry 18%, tip asymmetry 14%.
Surgeon findings: dorsal asymmetry 65%, wide dorsum 47%, nostril asymmetry 41%, wide alar base 38%, dorsal hump 30%.
Surgeon saw significantly more than patients: dorsal asymmetry 65% vs 33% (p = 0.0002); wide dorsum 47% vs 13%; wide alar base 38% vs 6%; dorsal hump 30% vs 9% (all p < 0.0001); columella protrusion 25% vs 6% (p = 0.0002).
Most common maneuvers: septoplasty 71%, alar rim graft 67%, dorsal graft 63%, osteotomy 60%, hump removal 46%.

What it means for a patient

Two thirds of people seeking a revision could not breathe well, which the authors call alarming and preventable at the first operation.
Surgeons notice asymmetries and width that patients do not; the revision plan will often include fixes the patient did not ask for.
One expert's practice; complaint and finding rates reflect who is referred there.

Why this paper matters

It quantifies the airway as the leading failure of primary rhinoplasty and lists the reconstruction toolkit revisions require. It does not report how the revisions turned out.

Terms

Secondary rhinoplasty: a repeat operation on a nose that has already had surgery.
Airway occlusion: blocked nasal breathing.
Alar rim graft: a thin cartilage strip placed along the nostril edge to support it.
Dorsal graft: cartilage laid on the bridge to smooth or raise it.
Osteotomy: a controlled cut through nasal bone to narrow or straighten it.
Alar base: where the nostrils meet the cheek.

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

From the abstract

“The purpose of this study was to identify the most common deformities seen preoperatively in secondary rhinoplasty patients and the required surgical maneuvers to correct them. Methods: A retrospective chart review of 100 consecutive secondary rhinoplasty patients was performed. Preoperative variables included…”

Excerpt; the full abstract is on PubMed.