Motivation for Revision Rhinoplasty Similar to that of Reconstructive Patients
Ninety-Seven Percent of Patients Satisfied With Revision, Reports Paper in Plastic and Reconstructive Surgery

Arlington Heights, Ill. - Most patients who seek repeated (secondary) cosmetic nose surgeries do so because of new or uncorrected deformities-similar to the reasons for patients undergoing primary rhinoplasty, suggests a report in the September issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Based on his experience of 150 secondary procedures, ASPS Member Surgeon Mark Constantian, MD, of St. Joseph Hospital and Southern NH Medical Center, Nashua, NH, concludes, "[T]he motivations of secondary rhinoplasty patients resemble those of most other aesthetic and reconstructive patients." His experience questions the perception that patients seeking repeated rhinoplasty are "demanding" or "difficult."

In Most Cases, Secondary Rhinoplasty Is Appropriate

Dr. Constantian performed the secondary procedures over a 16-month period in 2007-08. He analyzed the patients' reasons for surgery, any management issues, the surgeon's and patient's satisfaction with the results, and other issues. The patients were 121 women and 29 men, median age 42 years. They had undergone one to eight previous surgeries, with an average of 3.6 per patient.

For 41 percent of patients, the reason for repeat rhinoplasty was the development of a new deformity-for example, a previously straight nose that had become crooked. In 33 percent, the first rhinoplasty failed to correct the original deformity.

Another 15 percent of patients perceived the loss of desired "personal, familial, or ethnic characteristics." One percent had new or continued problems with airflow obstruction. "Thus the majority (90 percent) sought surgery to correct residual or new deformities, to restore personal characteristics than had been lost, or to correct functional complaints," writes Dr. Constantian.

Only 10 percent of patients were seeking further improvement in an "already acceptable result," as judged by Dr. Constantian. He rated this group of patients as having an average score of about 1 on a 5-point deformity scale, compared to 3 or higher in the other groups.

Dr. Constantian had previously operated on 16 of the patients; in 12 cases, he agreed that the repeat surgery was appropriate. Overall, 14 percent of patients were considered "demanding" by the surgeon and staff, while 27 percent had possible depression. Overall, 97 percent of patients were happy with their outcomes.

Few Patients Have Body Dysmorphic Disorder

Just three patients met criteria for body dysmorphic disorder (BDD)-a psychiatric disorder in which patients have excessive concerns about their physical appearance that interferes with daily life. Previous reports have suggested high rates of BDD among patients undergoing multiple plastic surgery procedures.

Patients seeking second (or more) rhinoplasties are often considered problematic by plastic surgeons. Such patients may be seen as "excessively demanding, often depressed, and impossible to please."

But Dr. Constantian questions those perceptions-his experience suggests that 90 percent of patients have appropriate cosmetic or functional reasons for repeat rhinoplasty. He points out that nearly three-fourths of patients in his study had deformities that either developed after or weren't corrected by the original surgery. "To these patients, the first operation had either been wasted or had done harm."

Dr. Constantian believes that a careful selection process-including evaluation of the patient's expectations and ability to handle possible complications-may have led to a lower rate of "severely unhappy patients" in his practice. Noting the spectrum of body dysmorphic symptoms, he plans a more in-depth analysis of patients who undergo multiple plastic surgeries but fall short of meeting criteria for BDD.

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.