Current Predictors of Revision at Time of Primary Rhinoplasty

Before primary rhinoplasty, it is crucial to identify patients whose concerns may not be adequately addressed by surgery. In 1999, Gorney and Martello introduced SIMON to describe patients who may be unsatisfied: single, immature, male, overly expectant, and narcissistic. This paper advocates for an evidence-based mnemonic to enhance patient selection.

TriNetX database medical records were queried for patients who underwent primary rhinoplasty at least three years ago at ≥ 15 years old. A Cox proportional hazards model quantified relationships between 115 patient variables, including SIMON-like characteristics, and risk of revision rhinoplasty.

Of 101,562 patients, more female patients underwent revision rhinoplasty than male patients (p = 0.062). Revision risk was 16.8× higher with social exclusion/rejection; 5.36× higher with personality disorders; 3.45× higher with history of subcutaneous filler injections; 2.64× higher with anxiolytic or sedative dependence; 1.38× higher with male sex; and 1.16× higher with anxiolytic use. "Married" relationship status, BMI > 30, older age at surgery, and diagnosed deviated septum were negative associations with revision rhinoplasty.

In the current day, additional nuance in social relationships, surgical history, psychiatric diagnosis, and surgical indication may be required to predict revision rhinoplasty. We propose an acronym, BLAKE: Borderline/personality disorders, Lonely/social exclusion, Anxiolytics/sedatives, Kosmetik focus, and previous Enhancement with fillers. BLAKE captures the most salient predictors of revision at the time of primary rhinoplasty, updating the SIMON acronym to be non-gendered and nonreligious.

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