Correction of the Over-resected Nose

The Effectiveness of Skeletal Reconstruction in Severe Post-Rhinoplasty Nasal Deformity

BACKGROUND

Revision rhinoplasty in patients with multiple prior surgeries is among the most challenging procedures in facial plastic surgery. Evaluating patient satisfaction in this unique patient population is important in determining which technique is effective.

OBJECTIVES

The aim of this study was to determine the outcomes of total nasal skeletal reconstruction in patients with severe post-rhinoplasty deformity due to multiple previous revision surgeries.

METHODS

A retrospective medical record analysis of ambulatory surgery and hospital databases was performed relating to rhinoplasty patients between April 2014 and December 2018. Patient demographics, surgical technique, and functional and aesthetic outcome assessment data were retrieved. Patients' functional satisfaction was measured with the Nasal Obstruction Symptom Evaluation (NOSE) instrument, and the Rhinoplasty Outcome Evaluation (ROE) instrument was used to evaluate cosmetic results.

RESULTS

A total of 253 revision rhinoplasties were extracted. Of these, 25 patients were revision cases with total skeletal reconstruction. The patients had undergone a mean of 3.2 previous rhinoplasties. Mean [standard deviation] preoperative ROE and NOSE scores were 6.36 [3.69] and 80.33 [12.02], respectively. Septum, tip, dorsum, and side walls were reconstructed in all cases. The mean postoperative ROE and NOSE scores after 1 year were 17.27 [4.67] and 53.33 [19.80], respectively, which represented a statistically significant improvement (P < 0.001).

CONCLUSIONS

Having the knowledge and experience to perform total nasal skeletal reconstruction by rebuilding an unsalvageable nose leads to long-standing satisfactory functional and aesthetic results.

LEVEL OF EVIDENCE: 4

Nasal Tip Deformities After Primary Rhinoplasty

Nasal tip deformities after primary rhinoplasty may occur, including the formation of bossae, a pinched nasal tip, and nasal tip ischemia. Because of the central location in the midface, even minimal nasal tip deformities (small bossa) may be noticed and upsetting to the patient. This is in addition to more severe nasal tip deformities, including nasal tip ischemia, that are easily visible to any viewer. Prevention, early recognition, and, depending on the case, intervention are critical in minimizing these complications. If complications do occur, regular communication with the patient and follow-up are crucial.