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

Another population to consider are those who are seeking a revision rhinoplasty. Generally, it is advisable to
wait for a full year after an initial surgery before undertaking a revision, although there are notable
exceptions. Some patients can be offered non-surgical interventions (e.g., filler) to address minor
complaints instead of up-front formal revision. For patients who are deemed acceptable candidates for
revision surgery, clear communication regarding the surgical plan is paramount. Again, informed consent
should emphasize the risks, including the risks of postoperative dissatisfaction and the possible need for
further surgery.

Nothing works all the time. In a number of rhinoplasties requiring revision, complications occur not
because of, but despite the surgical efforts undertaken. For example, the senior author has seen inverted V
deformities in patients who had the middle vault well reconstructed with spreader grafts, and he has seen
twisting and distortion of the nasal tip in patients who had no violation or resection of the tip cartilages. The
healing forces create a certain amount of unpredictability, so that complications can (and do) still occur
despite the best efforts of experienced surgeons. It is important to realize that the existence of an
unacceptable cosmetic result does not in and of itself mean that a surgical misadventure took place; that is
to say, it does not imply blame. With this in mind, the senior author has found that it is beneficial to
acknowledge any plainly visible abnormalities to the patient and express regret for their occurrence. It is not
[53]
surprising that physicians who apologized were also less likely to be subject to a malpractice claim .
The best outcome in rhinoplasty is a happy patient and a happy surgeon. In many cases, this proves to be a
straightforward undertaking. However, this chapter addresses the patients for whom this outcome proves to
be more difficult. These patients require more than surgical expertise. If one looks at these difficult and
challenging situations as an opportunity and leans into the effort to make these patients as happy as they
can be, the result can be most rewarding. That being said, when a surgeon occasionally finds that the
treatment or guidance they are providing to a particular patient is not working, then it is best to
compassionately refer the patient to a colleague who would be willing to provide the kind of care that is
required.

In summary, patient satisfaction is critical for a rhinoplasty to be considered successful. Objective structural
aesthetic concerns were most often related to residual dorsal hump or tip irregularities. Male sex, younger
age, and history of body dysmorphic disorder or abuse/neglect, and overall satisfaction with healthcare were
risk factors for dissatisfaction. Patients often sought revision rhinoplasty due to failure to correct the
original deformity or the development of a new deformity. Several additional avenues should be explored in
future studies, as factors including differences in insurance coverage, sex of the surgeon, patient
race/ethnicity, and surgeon expertise might also affect patient satisfaction. Despite all these factors, adequate
preoperative counseling and consent, effective communication, and arriving at a consensus on surgical goals
are all effective tools in the management of the dissatisfied patient in which a happy surgeon and a happy
patient is the ultimate goal.

DECLARATIONS
Authors’ contributions
Performed acquisition, analysis, and interpretation for the work, drafted the work, gave final approval of the
version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions
related to the accuracy or integrity of any part of the work are appropriately investigated and resolved:
Zhang K
Substantially contributed to the conception and design of the work, reviewed it critically for important
intellectual content, gave final approval of the version to be published, and agreed to be accountable for all