The Effectiveness of Skeletal Reconstruction in Severe Post-Rhinoplasty Nasal Deformity

Sazgar AA, Hajialipour S, Razfar A, Rahavi-Ezabadi S.

What this paper says

In 25 patients who had already had an average of 3.2 rhinoplasties, total rebuilding of the nasal framework improved appearance scores from 6.36 to 17.27 and breathing scores from 80.33 to 53.33 at one year.

Overview

Revision rhinoplasty in patients with several previous operations is among the most difficult procedures in facial plastic surgery. The study assessed outcomes of total nasal skeletal reconstruction, meaning rebuilding the entire framework, in patients with severe deformity after repeated surgery. Records from ambulatory surgery and hospital databases covering April 2014 to December 2018 were reviewed retrospectively.

Sections of note

Retrospective record analysis; 253 revision rhinoplasties were extracted and 25 were total skeletal reconstructions.
Patients had undergone a mean of 3.2 previous rhinoplasties.
Breathing was measured with the NOSE instrument, where higher scores mean worse obstruction, and appearance with the ROE instrument.
Mean preoperative ROE was 6.36, standard deviation 3.69, and mean preoperative NOSE was 80.33, standard deviation 12.02.
Septum, tip, dorsum and side walls were reconstructed in all cases.
Mean postoperative ROE at one year was 17.27, standard deviation 4.67, and mean NOSE was 53.33, standard deviation 19.80.
Both changes were statistically significant, P less than 0.001.

What it means for a patient

Patients started with severe obstruction, averaging 80 out of 100 on the NOSE scale, and remained obstructed at 53 after surgery.
Appearance scores improved but remained low in absolute terms.
Rebuilding everything did not restore normal function or normal satisfaction; it improved a very poor starting point.
Twenty five patients at one centre, reviewed retrospectively without a comparison group, is limited evidence.

Why this paper matters

Multiply operated noses are the hardest problem in the field, and there is little published outcome data on total reconstruction. This study supplies before and after scores using validated instruments. It does not identify which patients benefit most or how the results hold beyond one year.

Terms

Total nasal skeletal reconstruction: rebuilding the entire bone and cartilage framework of the nose.
NOSE: the Nasal Obstruction Symptom Evaluation, where higher scores mean worse breathing.
ROE: the Rhinoplasty Outcome Evaluation, where higher scores mean greater satisfaction.
Revision rhinoplasty: surgery on a nose that has already been operated on.
Dorsum: the bridge of the nose.

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

From the abstract

“Revision rhinoplasty in patients with multiple prior surgeries is among the most challenging procedures in facial plastic surgery. Evaluating patient satisfaction in this unique patient population is important in determining which technique is effective. Objectives: The aim of this study was to determine the outcomes…”

Excerpt; the full abstract is on PubMed.