Page 41 - Read Online

Zhang et al. Plast Aesthet Res 2024;11:23 Plastic and
DOI: 10.20517/2347-9264.2023.111
Aesthetic Research

Review Open Access

Persistent cosmetic dissatisfaction in rhinoplasty &
management of the difficult patient

2
1
Kathy Zhang , Emily C. Deane , Daniel G. Becker 2,3
1
Division of Otolaryngology - Head & Neck Surgery, Cooper University Health Care, Camden, NJ 08103, USA.
2
Department of Otolaryngology Head & Neck Surgery - Facial Plastic & Reconstructive Surgery, University of Pennsylvania,
Philadelphia, PA 19104, USA.
3
Penn Medicine Becker ENT and Allergy, University of Pennsylvania, Voorhees, NJ 08043, USA.
Correspondence to: Dr. Kathy Zhang, Division of Otolaryngology - Head & Neck Surgery, Cooper University Health Care, 1
Cooper Plaza, Camden, NJ 08103, USA. E-mail: zhang-kathy@cooperhealth.edu
How to cite this article: Zhang K, Deane EC, Becker DG. Persistent cosmetic dissatisfaction in rhinoplasty & management of the
difficult patient. Plast Aesthet Res 2024;11:23. https://dx.doi.org/10.20517/2347-9264.2023.111

Received: 10 Nov 2023 First Decision: 23 May 2024 Revised: 12 Jun 2024 Accepted: 19 Jun 2024 Published: 26 Jun 2024

Academic Editors: Paolo Boffano Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
The rhinoplasty surgeon will undoubtedly encounter a cosmetic patient who is persistently dissatisfied with their
results, no matter the objective outcome achieved. This article seeks to describe risk factors for postoperative
dissatisfaction and highlight effective management strategies for the “difficult patient.” A literature search was
performed using PubMed and Embase databases during September and October of 2023 to identify articles that
analyzed factors related to dissatisfaction in rhinoplasty. Forty unique references were identified. The majority of
structural aesthetic complaints related to dissatisfaction after rhinoplasty were residual dorsal hump (20%) or
persistent tip dissatisfaction (19%-37%). Demographic factors including younger age, male sex, self-referral,
history of body dysmorphic disorder or abuse/neglect were risk factors for postoperative dissatisfaction.
Ineffective patient-provider communication, litigation due to inadequate informed consent, and surgeon
inattentiveness were contributing factors to postoperative dissatisfaction. Revision rhinoplasty rates ranged from
5%-15%, where most patients sought revision surgery due to the development of a new deformity or failure to
correct the original deformity, with the greatest complaints at the nasal bridge and nasal tip. Validated
patient-reported outcome measures including Rhinoplasty Outcome Evaluation (ROE) and FACE-Q can be
effective questionnaires to assess satisfaction. Appropriate patient selection, adequate preoperative counseling
and consent, effective communication, and reaching a consensus about surgical goals are all effective strategies in
the management of a dissatisfied patient.

Keywords: Complaints, dissatisfaction, rhinoplasty, perception, revision rhinoplasty

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

www.oaepublish.com/par