Adjustment of subtle postoperative nasal defects: managing the "near-miss" rhinoplasty

Rhinoplasty entails several steps that affect the appearance and function of the nose in an interrelated way. Occasionally, an excellent result can be marred by a minor imperfection and lead to dissatisfaction of both patient and surgeon. For significant pathology, revision rhinoplasty can be performed safely if the architecture and physiology of the nose are respected. To correct the "near-miss" result, minor corrections can successfully restore the aesthetic result. This can require a different frame of reference and approach and can often be thought of in terms of soft tissue correction. Subcutaneous fibrosis, skin depressions, asymmetries, and deficits can be corrected with minor procedures and techniques not routinely associated with rhinoplasty. We detail several methods that can be used to restore simply and effectively an otherwise excellent rhinoplasty result.