Primary and Revision Rhinoplasty: A Single Surgeon Experience and Patient Satisfaction

Suresh R, Doval AF, Newstrom E, Pham T, Alford EL.

PubMed 34522571 Publisher (DOI)Free full text (PMC)

What this paper says

Across 102 rhinoplasties by one surgeon, middle vault collapse was significantly more common in revision patients, and revision patients reported higher dissatisfaction after surgery.

Overview

Little has been published on what characteristics distinguish patients seeking first time surgery from those seeking revision, and success is usually judged from the surgeon's viewpoint rather than the patient's. The study aimed to compare anatomic and functional characteristics between the two groups, assess satisfaction by survey, and test whether graft choice affects satisfaction in revision cases.

Sections of note

Retrospective review of all rhinoplasties by a single surgeon from June 2016 to January 2020.
One hundred and two rhinoplasties were included: 53 primary and 49 revision.
Primary patients more often had noses the study describes as big, P equals 0.015, or humps, P less than 0.010.
Revision patients more commonly had middle vault collapse, P equals 0.022.
The survey response rate was 60 percent.
Revision patients had a higher incidence of dissatisfaction with their outcome.
Survey outcomes were compared between patients receiving ear cartilage and rib cartilage grafts in revision surgery.
The authors state several features seen in revision patients could have been created by the first operation.

What it means for a patient

Middle vault collapse, a narrowing and pinching of the middle of the nose, was concentrated in patients who had already been operated on, suggesting it can be caused by the first surgery.
Revision patients were less satisfied afterward than first time patients.
The survey reached only 60 percent of patients, so non responders may differ from responders.
The abstract does not report the result of the ear versus rib graft comparison.

Why this paper matters

The features that bring patients back for revision may be created rather than inherited, and this study identifies one such feature. It also measures satisfaction from the patient side rather than the surgeon's. Whether graft choice changes revision satisfaction is left unanswered in the abstract.

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.
Middle vault collapse: narrowing or pinching of the middle third of the nose, which can block breathing.
Auricular cartilage: cartilage taken from the ear.
Costal cartilage: cartilage taken from the rib.

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

Abstract

Unlabelled: There is minimal information describing the common characteristics among patients seeking primary/revision rhinoplasty. Success is traditionally interpreted from the surgeon's viewpoint, without considering the patient's perspective. The study's aims were to (1) identify/compare anatomic and functional characteristics commonly found in patients seeking primary and revision rhinoplasties; (2) assess patient satisfaction using a survey; and (3) explore whether graft choice (auricular cartilage versus rib cartilage) affects patient satisfaction and outcome in revision rhinoplasty.

Methods: A retrospective review of all rhinoplasties by a single surgeon from June 2016 to January 2020 was performed, focusing on preoperative anatomic/functional characteristics and operative interventions performed. A survey was then used to assess patient satisfaction. Finally, survey outcomes were compared between patients who received auricular and rib cartilage grafts in revision rhinoplasty.

Results: A total of 102 rhinoplasties (53 primary and 49 revisions) were included. Primary rhinoplasties were noted to have more patients with "big" noses (P = 0.015) or humps (P < 0.010). Patients undergoing revision rhinoplasties more commonly exhibited middle vault collapse (P = 0.022). The survey response rate was 60%. Revision rhinoplasty patients had a higher incidence of dissatisfaction with their outcome.

Conclusions: Several features among patients seeking revision rhinoplasties could have been created in the primary operation. The rhinoplasty surgeon should be careful to not introduce new issues or create worse deformities than those seen following the initial operation. Survey-based outcome analysis demonstrated that revision rhinoplasty patients are more likely to have a greater rate of dissatisfaction following their operation.

Abstract as indexed by PubMed; the article is open access (PubMed Central).