Abstract
Of the many challenges in rhinoplasty, achieving a satisfactory outcome at the first
operation is important. There are multiple reasons for secondary surgery, and generally
revisions can be broadly classified into minor (often one area of deficit) or a total
redo. Understanding the common technical reasons for failure in primary surgery by
analyzing the deformities has resulted in various error patterns emerging. Understanding
these patterns means we can modify techniques in primary surgery to reduce the incidence
of revision. This article describes our prospective revision rhinoplasty experience
over 5 and then 2 years, highlighting the main error patterns encountered. We also
describe a stepwise analysis of four frequently encountered key problem areas alongside
techniques to address them and offer pearls to help prevent further revision. Comparison
of two cohorts of patients from a teaching hospital setting and private practice with
the same operating surgeon indicates an increasing tendency to the open approach for
revisions. The re-revision rates for these groups are 15.7 and 9%, respectively. Revision
rhinoplasty is a difficult operation to perform to the satisfaction of both the surgeon
and the patient. Understanding the common technical reasons for failure in primary
surgery by fully analyzing the deformities means we can modify techniques in primary
surgery to reduce the incidence of revision.
Keywords
rhinoplasty - nasal deformity - secondary nasal surgery - septorhinoplasty
