Revision Rhinoplasty after Open Rhinoplasty: Lessons from 252 Cases and Analysis of Risk Factors

Overview

The study screened patients who needed aesthetic revision after open rhinoplasty for risk factors. Two hundred and fifty two patients who underwent revision were included. The deformity present before each revision was recorded and tested statistically against the patient's nasal shape before the original surgery and against the surgical techniques used.

Sections of note

• Retrospective analysis of 252 revision patients; risk study, level of evidence III.
• The overall revision rate was 10.8 percent.
• The three commonest aesthetic reasons for revision were insufficient tip rotation, 37.7 percent, hanging columella, 30.2 percent, and supratip deformity, 28.6 percent.
• Using a strut increased the risk of inadequate tip rotation 5.3 fold compared with the tongue in groove technique.
• Inadequate tip projection before surgery doubled the risk of inadequate rotation.
• Being older than 40 increased the risk of hanging columella 6.8 fold.
• Using a strut instead of tongue in groove increased hanging columella risk 5.9 fold and supratip deformity risk 2.2 fold.
• The authors recommend tongue in groove, or over rotating the tip, in older patients with low tip projection and rotation.

What it means for a patient

• About one in nine patients in this practice needed a further operation.
• Two thirds of revisions concerned the tip area, specifically its rotation, the columella hanging low, or a fullness above the tip.
• The technique used to fix the tip was the strongest modifiable factor identified.
• This is retrospective single centre data, so the technique comparison was not randomized and other differences between cases may explain the result.

Why this paper matters

Tip technique choice is made in every rhinoplasty and its downstream consequences are rarely quantified. This study links two common tip methods to specific later deformities with numerical risk estimates. Whether switching technique reduces revisions prospectively has not been shown.

Terms

• Tongue in groove: sliding the tip cartilages onto the front edge of the septum to set tip position.
• Strut graft: a cartilage post placed between the nostrils to support the tip.
• Tip rotation: how far upward the tip is angled.
• Hanging columella: the strip between the nostrils sitting lower than the nostril rims.
• Supratip deformity: a fullness or bulge on the bridge just above the tip.
• Logistic regression: a statistical method predicting a yes or no outcome from several factors.