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The Frequency of the Flaws and Commonly Required Maneuvers To Correct Them: A Guide to Reduction of Secondary Rhinoplasties
Michelle Lee, MD, Samantha Zwiebel, BS, Bahman Guyuron, MD
Case Western Reserve University
2013-02-19
Presenter: Michelle Lee
Affidavit:
100% of the work is the original work of the resident
Director Name: Hooman Soltanian MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Aesthetics
PURPOSE:
To identify the most common deformities seen in secondary rhinoplasty and the required surgical maneuvers to correct them.
METHODS:
A retrospective review of 100 consecutive secondary rhinoplasty patients was performed. Preoperative variables included demographics, prior rhinoplasty data, the patient's main concerns and the senior author's physical examination of the nose. Operative maneuvers necessary to correct the imperfections were reviewed.
RESULTS:
All patients had previous rhinoplasties by other surgeons. The most common preoperative complaints were: airway occlusion (65%), dorsum deviation (18%), nostril asymmetry (18%), dorsum asymmetry (15%), and tip asymmetry (14%). The most common preoperative nasal deformities seen by the senior author were: dorsal deviation (55%), wide dorsum (47%), nostril asymmetry (41%), wide alar base (38%), and dorsal hump (30%). The senior author saw significantly more nasal deformities than the patients themselves, especially in: dorsal deviation (55% vs. 18%, p<0.0001), wide dorsum (47% vs. 13%, p<0.0001), nostril asymmetry (41% vs. 18%, p=0.0003), wide alar base (38% vs. 6%, p<0.0001), dorsal hump (30% vs. 9%, p<0.0001), and columella protrusion (25% vs 6%, p=0.0002). The most common revision rhinoplasty surgical maneuvers were: septoplasty (71%), alar rim graft (67%), dorsal graft (63%), osteotomy (60%), and dorsal hump removal (46%).
CONCLUSION:
The high incidence of airway concerns among secondary rhinoplasty patients is alarming and emphasizes the urgent need to pay attention to the airway during primary rhinoplasty. Also, understanding common problems seen in revision rhinoplasty patients and associated surgical maneuvers for correction may guide the less experienced surgeons to avoid these common technical misjudgments during primary rhinoplasty.
