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The Frequency of the Flaws and Commonly Required Maneuvers To Correct Them: A Guide to Reduction of Secondary Rhinoplasties
Michelle Lee, MD, Samantha Zwiebel, BS, Bahman Guyuron, MD.
Case Western Reserve University, Cleveland, OH, USA.
PURPOSE:
The goal of this study was to identify the most common deformities seen in secondary rhinoplasty patients and the required surgical maneuvers to correct them in order to offer some guidance to reducing the frequency of these procedures.
METHODS:
A retrospective chart review of 100 consecutive secondary rhinoplasty patients was performed. Preoperative variables included patient demographics, prior rhinoplasty data, the patient’s main aesthetic/functional concerns and the senior author’s physical examination of the nose and identified flaws. The details of the operative maneuvers necessary to correct the residual or iatrogenic imperfections were reviewed.
RESULTS:
The average age of the 100 revision rhinoplasty patients was 39.2 years. Female to male ratio was 77:23. Average number of prior rhinoplasties was 1.8. All patients had previous rhinoplasties by other surgeons. The most common preoperative patient complaints were: airway occlusion (65%), dorsum deviation (18%), nostril asymmetry (18%), dorsum asymmetry (15%), and tip asymmetry (14%). The most common preoperative nasal deformities seen by the senior author were: dorsal deviation (55%), wide dorsum (47%), nostril asymmetry (41%), wide alar base (38%), and dorsal hump (30%). The senior author saw significantly more nasal deformities than the patients themselves, especially in the following areas: dorsal deviation (55% vs. 18%, p<0.0001), wide dorsum (47% vs. 13%, p<0.0001), nostril asymmetry (41% vs. 18%, p=0.0003), wide alar base (38% vs. 6%, p<0.0001), dorsal hump (30% vs. 9%, p<0.0001), and columella protrusion (25% vs 6%, p=0.0002). The most common revision rhinoplasty surgical maneuvers were: septoplasty (71%), alar rim graft (67%), dorsal graft (63%), osteotomy (60%), and dorsal hump removal (46%).
CONCLUSION:
The high incidence of airway concerns among secondary rhinoplasty patients is alarming and emphasizes the urgent need to pay attention to the airway during primary rhinoplasty and to include maneuvers that will aid in maintaining the airway or improving a compromised airway. Also, understanding common problems seen in revision rhinoplasty patients and associated surgical maneuvers for correction may guide the less experienced surgeons to avoid these common technical misjudgments or errors during primary rhinoplasty. In regards to nasal imperfections, there is often a disparity between what the patient sees and what the surgeon observes.
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