Comparison of Changes in Nasal Skin Sensation After Primary and Revision Rhinoplasty Procedures Using Semmes-Weinstein Monofilament Testing

Overview

Numbness of the nasal skin is one of the commonest complications after rhinoplasty. This prospective randomized blinded study measured how sensation changed after first time and revision open rhinoplasty and how far it recovered in each group. Testing used Semmes Weinstein monofilaments, calibrated nylon threads that apply a known pressure, applied at seven marked points on the nose.

Sections of note

• Prospective randomized blinded study; 100 primary patients, 34 revision patients and 50 volunteer controls.
• Testing was done before surgery and at months 1, 3, 6 and 12.
• In primary patients, the change in reduced pressure sensation over time was significant at the tip and infratip, P less than 0.001, with no significant difference at the other points.
• In revision patients, the change was significant at the tip, infratip and base of the columella, P less than 0.001.
• Comparing revision against primary patients at all time points, sensation was significantly reduced at all points in the revision group, P less than 0.001.
• By month 12, primary patients had normal touch sensation except at the tip and infratip.
• Revision patients still had reduced sensation at 12 months, greatest at the tip, infratip and columellar base.

What it means for a patient

• Numbness after rhinoplasty is real and measurable, concentrated at the tip and the area just beneath it.
• After a first operation most of it resolves within a year, though tip sensation may not.
• After revision surgery, reduced sensation persisted across the whole nose at one year.
• The revision group had only 34 patients, and the study did not follow anyone beyond 12 months.

Why this paper matters

Numbness is commonly mentioned in consent but rarely quantified or tracked. This study measures it objectively over a year and separates first time from repeat surgery. Whether tip sensation recovers after 12 months is not answered.

Terms

• Semmes Weinstein monofilament: a calibrated nylon thread used to test how much pressure a patient can feel.
• Infratip: the area just below the tip of the nose.
• Columella: the strip of tissue between the two nostrils.
• Open rhinoplasty: surgery through an incision across the columella, lifting the nasal skin.
• Revision rhinoplasty: surgery on a nose that has already been operated on.