Primary and Revision Rhinoplasty: A Single Surgeon Experience and Patient Satisfaction

Abstract

Background: There is minimal information describing the common characteristics among patients seeking primary/revision rhinoplasty. Success is traditionally interpreted from the surgeon's viewpoint, without considering the patient's perspective. The study's aims were to (1) identify/compare anatomic and functional characteristics commonly found in patients seeking primary and revision rhinoplasties;(2) assess patient satisfaction using a survey; and (3) explore whether graft choice (auricular cartilage versus rib cartilage) affects patient satisfaction and outcome in revision rhinoplasty. Methods: A retrospective review of all rhinoplasties by a single surgeon from June 2016 to January 2020 was performed, focusing on preoperative anatomic/functional characteristics and operative interventions performed. A survey was then used to assess patient satisfaction. Finally, survey outcomes were compared between patients who received auricular and rib cartilage grafts in revision rhinoplasty. Results: A total of 102 rhinoplasties (53 primary and 49 revisions) were included. Primary rhinoplasties were noted to have more patients with "big" noses (P = 0.015) or humps (P < 0.010). Patients undergoing revision rhinoplasties more commonly exhibited middle vault collapse (P = 0.022). The survey response rate was 60%. Revision rhinoplasty patients had a higher incidence of dissatisfaction with their outcome Conclusions: Several features among patients seeking revision rhinoplasties could have been created in the primary operation. The rhinoplasty surgeon should be careful to not introduce new issues or create worse deformities than those seen following the initial operation. Survey-based outcome analysis demonstrated that revision rhinoplasty patients are more likely to have a greater rate of dissatisfaction following their operation.

Persistent cosmetic dissatisfaction in rhinoplasty & management of the difficult patient

“…Another study that included the investigation of claims related to blepharoplasty, rhinoplasty, and rhytidectomy showed that 38.6% of cases alleged a lack of informed consent [34] . In a literature review evaluating 24 different consent forms used for rhinoplasty, the authors found that "unsatisfactory results" and "need for revision" were only covered in 83.3% and 75.0% of consent forms, respectively [35] . Despite this, they reported that these complications were among the top 5 cited in literature.…”

Reporting of Complications in Rhinoplasty Randomized Controlled Trials: An Analysis Using the CONSORT Extension for Harms Checklist

“…1,2 Despite its everyday performance, rhinoplasty remains a complicated cosmetic and functional procedure that helps improve nasal respiration and relieve obstruction, with up to 20% of these surgeries requiring subsequent revisions. [3][4][5][6] As such, surgical complications are common and range in severity from a superficial hematoma, and wound infection, to even death. 4 Given the frequency and complexity involved in rhinoplasties, 1-way surgeons may mitigate these risks is by extensively reviewing the current literature and surgical advancements in operative technique before choosing the surgical approach or the type of rhinoplasty needed.…”

“…[3][4][5][6] As such, surgical complications are common and range in severity from a superficial hematoma, and wound infection, to even death. 4 Given the frequency and complexity involved in rhinoplasties, 1-way surgeons may mitigate these risks is by extensively reviewing the current literature and surgical advancements in operative technique before choosing the surgical approach or the type of rhinoplasty needed. Often surgeons can find these risks within properly conducted randomized control trials (RCTs).…”

“…Rhinoplasty is one of the most common facial plastic and reconstructive surgery procedures in the world—200,000 to 350,000 are performed each year in the US alone 1,2 . Despite its everyday performance, rhinoplasty remains a complicated cosmetic and functional procedure that helps improve nasal respiration and relieve obstruction, with up to 20% of these surgeries requiring subsequent revisions 3‐6 . As such, surgical complications are common and range in severity from a superficial hematoma, and wound infection, to even death 4 .…”