Differences between Primary and Revision Rhinoplasty: Indications, Techniques, Grafts, and Outcomes

Overview

The authors note that rhinoplasty demand has risen with selfies and social media, and that demand for corrective surgery has risen with it. Revision rhinoplasty is more complex than a first operation and often needs grafting material from outside the nose. This retrospective analysis compared indications, techniques and outcomes between the two groups at a specialized facial plastic surgery clinic, all patients treated by an experienced surgeon under established clinic standards.

Sections of note

• Retrospective analysis of 245 patients: 153 primary cases and 92 revisions; therapeutic level of evidence IV.
• More revision patients sought surgery for appearance alone than for breathing alone.
• Almost two thirds of revision patients had combined appearance and breathing problems.
• Complex reconstructive techniques were used more often in revision cases.
• Extracorporeal septoplasty, in which the septum is removed, rebuilt and replaced, was more common in revisions.
• Grafts from outside the nose were also more common in revisions.
• A further revision during follow up occurred in 10.5 percent of primary cases and 23.9 percent of revision cases, P equals 0.006.
• The authors state patients should be told about the greater complexity, the possible need for grafts from outside the nose, and the higher risk of another revision.

What it means for a patient

• A second operation is more than twice as likely to need a third than a first operation is to need a second.
• Revision surgery usually means taking cartilage from the ear or rib, since septal cartilage is often already used.
• Most revision patients had both breathing and appearance complaints rather than appearance alone.
• This is one clinic's retrospective data, and the follow up period is not stated in the abstract.

Why this paper matters

Revision rates are the most concrete measure of rhinoplasty outcome, and this study separates them by whether the nose had been operated on before. It quantifies the escalation patients face. Which factors within revision surgery drive the higher rate is not identified.

Terms

• Primary rhinoplasty: a first operation on a nose with no previous surgery.
• Revision rhinoplasty: surgery on a nose that has already been operated on.
• Extracorporeal septoplasty: removing the septum, rebuilding it outside the nose and replacing it.
• Extranasal graft: grafting material taken from outside the nose, such as ear or rib.
• Functional problem: a breathing problem, as distinct from appearance.