Presenting concerns and surgical management of secondary rhinoplasty

Overview

Secondary rhinoplasty means operating on a nose that has already been operated on, and the reasons patients come back are not well catalogued. The authors reviewed 109 consecutive secondary cases performed by one surgeon between 2009 and 2012, recording what the patient complained of, what was found on examination, and what was done to correct it.

Sections of note

• Retrospective review of 109 patients, all operated by the senior author.
• Mean age at surgery 33.2 years, range 18 to 61. Women made up 71.6 percent.
• Mean number of previous nasal operations was 1.6, range 1 to 8.
• Chief complaints: asymmetry 36.7 percent, large tip 24.8 percent, breathing difficulty 22.0 percent.
• Most common findings on examination: nostril asymmetry 33.9 percent, septal deviation 32.1 percent, over-resection 26.6 percent, tip asymmetry 26.6 percent.
• Level of evidence 4, therapeutic.

What it means for a patient

• The most frequent reason people seek revision is that the nose is uneven, not that it is the wrong size.
• Roughly one in four patients had too much tissue removed at the first operation, a problem that requires adding grafts rather than removing more.
• Nearly a quarter came back for breathing problems, which is a reminder that function and appearance are linked.
• Some patients had up to eight previous operations, so the group is not representative of first-time rhinoplasty patients. Single surgeon, no comparison group, no outcome scores reported.

Why this paper matters

Revision rhinoplasty is widely described as the hardest work in the field, and knowing what actually goes wrong the first time guides both technique and consent. Over-resection appearing in a quarter of cases supports the modern shift toward preserving and rebuilding structure rather than removing it. The paper catalogues problems without measuring how well the revisions solved them.

Terms

• Secondary or revision rhinoplasty: an operation to correct the result of a previous nose operation.
• Asymmetry: the two sides of the nose not matching.
• Septal deviation: a bent central partition inside the nose, which can block airflow.
• Over-resection: removal of too much bone or cartilage at an earlier operation.
• Nostril asymmetry: nostrils of unequal size or shape.
• Level of evidence 4: a case series without a control group.