Why Do They Return? A Phenomenological Study of the Lived Experiences and Ethical Dimensions of Revision Rhinoplasty...

Rhinoplasty is among the most common facial surgeries. Evidence indicates that the rate of revision rhinoplasty remains high, particularly in Iran. While the technical causes are well documented, the lived experiences and underlying motivations for repeated revisions remain largely unexplored. This phenomenological study aimed to explain patients' experiences and the fundamental reasons for undergoing revision rhinoplasty.

In this phenomenological study, using Colaizzi's method, participants were recruited from three teaching hospitals using purposive sampling. In-depth, semi-structured interviews were used for data collection and continued until data saturation. Data analysis followed Colaizzi's seven steps, utilising MAXQDA 12 software. Trustworthiness was ensured through member checking, peer debriefing, audit trail and reflexivity, in line with Lincoln and Guba's criteria. As an ethical commitment, all participants received a free clinical follow-up by an ENT specialist. To the best of our knowledge, this is the first study in Iran to explore the psychosocial and ethical dimensions of revision rhinoplasty from the patient's perspective.

Analysis of 18 in-depth interviews identified three interrelated themes crystallising around the central phenomenon: 'Reconstructing the Self: The Search for a Lost Identity'. Participants described experiences related to: (1) A Fractured Sense of Lived Wholeness: The Struggle to Reclaim a Lost Self, marked by an identity crisis stemming from the unattainable 'desired self' and loss of their pre-surgical identity; (2) Disruption of Embodied Functionality: The Severed Connection to the Corporeal Self, involving a loss of the functional self, breathing difficulties and bodily alienation; and (3) The Unravelling of the Cared-for Self: Navigating Therapeutic Disenchantment and the Quest for Reconstruction, characterised by striving for self-reconstruction amidst ineffective therapeutic encounters, including unrealistic promises and inadequate post-operative support.

Revision rhinoplasty in Iran extends beyond aesthetic concerns, representing an existential quest to reconstruct a self-fractured by profound identity loss, disrupted embodied functionality, and disillusionment with therapeutic processes. Centred on the phenomenon 'Reconstructing the Self: The Search for a Lost Identity', these findings underscore the critical need for ethically grounded, patient-centred approaches. These approaches should incorporate comprehensive psychosocial support and prioritise the preservation of bodily integrity within cosmetic surgical care.

Participants contributed to the validation of interpreted themes through member checking. As an ethical safeguard, all participants were offered a free ENT follow-up.