title: Rhinoplasty for the multiply revised nose.
abstract: OBJECTIVE
  To evaluate the problems encountered on revising a multiply operated nose and the methods used in correcting such problems.
  
  
  METHODS
  The study included 50 cases presenting for revision rhinoplasty after having had 2 or more previous rhinoplasties. An external rhinoplasty approach was used in all cases. Simultaneous septal surgery was done whenever indicated. All cases were followed for a mean period of 32 months (range, 1.5-8 years). Evaluation of the surgical result depended on clinical examination, comparison of pre- and postoperative photographs, and degree of patients' satisfaction with their aesthetic and functional outcome.
  
  
  RESULTS
  Functionally, 68% suffered nasal obstruction that was mainly caused by septal deviations and nasal valve problems. Aesthetically, the most common deformities of the upper two thirds of the nose included pollybeak (64%), dorsal irregularities (54%), dorsal saddle (44%), and open roof deformity (42%), whereas the deformities of lower third included depressed tip (68%), tip contour irregularities (60%), and overrotated tip (42%). Nasal grafting was necessary in all cases; usually more than 1 type of graft was used in each case. Postoperatively, 79% of the patients, with preoperative nasal obstruction, reported improved breathing; 84% were satisfied with their aesthetic result; and only 8 cases (16%) requested further revision to correct minor deformities.
  
  
  CONCLUSIONS
  Revision of a multiply operated nose is a complex and technically demanding task, yet, in a good percentage of cases, aesthetic as well as functional improvement are still possible.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Alexandria Medical School, Alexandria, Egypt. hfoda@dataxprs.com.eg
authors.forename: Hossam M T
authors.initials: HM
authors.lastname: Foda
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000523:psychology / Q000601:surgery*; D009300:Nasal Septum / Q000601:surgery; D009666:Nose / Q000601:surgery*; D009667:Nose Deformities, Acquired / Q000209:etiology / Q000601:surgery*; D017060:Patient Satisfaction; D010781:Photography; D011182:Postoperative Care; D012086:Reoperation; D012225:Rhinoplasty / Q000379:methods*; D016896:Treatment Outcome