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Zhang et al. Plast Aesthet Res 2024;11:23 https://dx.doi.org/10.20517/2347-9264.2023.111 Page 7 of 14

PATIENTS SEEKING REVISION RHINOPLASTY
The incidence of revision rhinoplasty ranges from 5%-15% [3,6-8] . Dissatisfaction with previous rhinoplasty
[36]
often stems from the failure to correct a pre-existing deformity, or the creation of a new deformity .
Chauhan et al. performed a retrospective review of 400 patients and compared complaints between patients
receiving primary (n = 308) versus secondary rhinoplasty (n = 92); patients seeking revision rhinoplasty
were far more likely to report “crooked nose” (38%), “tip asymmetry” (22%), “wide or large nostrils” (19%)
[37]
compared to primary rhinoplasty patients [Table 1]. It has also been reported that in some cases, the need
for revision rhinoplasty can be related to poorly performed preoperative evaluation, improper patient
selection, or failure to adequately explain the limitations of surgery, or intraoperative technical limitations
[38]
encountered .

Managing the patient who is dissatisfied with their previous rhinoplasty involves careful assessment of the
[39]
reasons for their prior unhappiness . As described by Ambro et al., the motivation for patients seeking
revision rhinoplasty can be grouped into three general categories: (1) Poor technical outcome; (2) Patients
dissatisfied with an acceptable but not perfect outcome; or (3) Patients dissatisfied with an objectively very
good technical outcome .
[40]
In a retrospective review of 150 patients who underwent revision rhinoplasty, the most common reason for
undergoing revision was development of a new deformity due to the previous rhinoplasty (44%), followed
by failure to correct the original deformity (33%) . Knowing which features are most likely to lead to a
[41]
[36]
patient seeking revision rhinoplasty can be invaluable during the preoperative planning process .
According to a retrospective study of 170 revision rhinoplasties, the lower third of the nose had the greatest
number of deformities including the drooped tip, the underprojected tip, tips with an undesirable shape
(pinched, bulbous, bossae), and retracted ala. Pollybeak deformity was most common in the middle third of
the nose . In a prospective study utilizing a questionnaire regarding motivation for revision rhinoplasty, the
[8]
most common cosmetic complaints reported by patients were dropped nasal tip (39.5%), elevated nasal
bridge (32.5%), and broad nasal base (20.9%) . Similarly, in a retrospective review with 183 patients who
[38]
completed the FACE-Q questionnaire, the most common cause for seeking revision rhinoplasty was due to
tip dissatisfaction (43.4%) and hump dissatisfaction (21.7%) .
[23]
Alternative sources of cartilage or grafting material might be required to reshape the nose in revision
rhinoplasty. A few studies have analyzed the effect of graft material on satisfaction rates, with no significant
difference in postoperative dissatisfaction between patients who received rib or auricular cartilage grafting
based on ROE satisfaction scores [2,36] and a subgroup analysis of a survey study . Therefore, when grafting
[36]
is necessary to reconstruct severe nasal deformities, surgeons should continue to employ them if needed.

Vian et al. reported that 11 out of 43 patients went to a different surgeon for their revision; the majority
reported seeking a different surgeon because they did not feel the first result was satisfactory and they did
not trust the surgeon . Similarly, in another study, nearly half of patients chose a different surgeon to
[38]
perform their revision, and about 23% of them stated they felt their first surgeon was not receptive to their
concerns . This could be reflected in the fact that over one-third of patients who reported their prior
[7]
rhinoplasty failed to correct the original deformity .
[41]

When a patient presents seeking revision rhinoplasty, the surgeon must carefully select who they will
operate on in the context of the surgeon’s expertise and the patient’s wishes in order to achieve the best
result. To understand reasons why a surgeon might decline to perform a revision rhinoplasty, a prospective
multicenter study by Greve et al. evaluated 186 patients seeking rhinoplasty and documented reasons for