Reducing the incidence of revision rhinoplasty

To evaluate reasons for revision rhinoplasty in a tertiary care setting to help reduce the incidence of revision rhinoplasty.

Retrospective review of 184 consecutive revision rhinoplasty cases performed by a single surgeon, evaluating the major reasons for patients seeking revision rhinoplasty surgery.

The senior author performed 539 rhinoplasty cases during the period January 2001 to June 2003. 184 were revision cases. Within this group 56 were the author's own revisions and 128 had undergone primary surgery by "other surgeons." Major revision indications were airway in 109, crookedness in 70, residual hump in 31 and irregularity in 25 cases. Less common problems included inadequate reduction, tip asymmetry, tip bossae, saddle deformity and change of mind. The incidence of airway restriction and crookedness in the author group was significantly less than in the other surgeon group (p<.0001 and p = .0002 respectively). Other indications did not differ significantly between the groups.

The pattern of problems requiring revision rhinoplasty is changing as the improved skills of the surgeon are countered by the increased demands of the patient. The high incidence of nasal obstruction following rhinoplasty reminds us that attention to the airway should not be compromised in the focus on cosmetic outcome. Crookedness of the nose has become a notable complaint by a discriminating public. All patients undergoing primary rhinoplasty need advice that revision rhinoplasty may be necessary either during or after the healing phase.