title: Cosmetic rhinoplasty: revision rates revisited.
abstract: BACKGROUND
  Cosmetic rhinoplasty has great potential to change a patient's appearance. It also carries the very real risk of patient dissatisfaction and request for revision. Although there have been many published patient series studying various aspects of rhinoplasty, questions remain regarding revision rates, as well as risk factors for complications, dissatisfaction, and revision.
  
  
  OBJECTIVE
  The authors investigate the rate of cosmetic rhinoplasty revision at a plastic surgery group practice and identify risk factors for revision.
  
  
  METHODS
  Medical records were retrospectively reviewed for all patients who presented to a single multisurgeon practice for primary rhinoplasty, septorhinoplasty, and revision rhinoplasty between 1998 and 2008. Patient demographics, preoperative complaints, preoperative physical examination findings, detailed operative data, and postoperative outcomes were abstracted from the charts. Complication rates, revision rates, and postoperative patient satisfaction were calculated and analyzed for identifiable risk factors.
  
  
  RESULTS
  Of 369 consecutive cosmetic rhinoplasties performed during the study period, 279 (72.7%) were conducted with an open approach. The overall complication, dissatisfaction, and revision rates were 7.9%, 15.4%, and 9.8%, respectively. Postoperatively, most patients (87%) were identified by their surgeons as having had successful anatomical correction of their nasal deformity. History of previous nasal operation or facial fracture, lack of anatomical correction, and occurrence of postoperative complications were associated with both revision and dissatisfaction (P < .05). Failure to address the nasal tip at the time of primary rhinoplasty was associated with a higher level of dissatisfaction.
  
  
  CONCLUSIONS
  Cosmetic rhinoplasty is one of the most challenging procedures in plastic surgery; however, these data indicate that a high level of patient satisfaction is attainable within a plastic surgery group practice if certain factors are considered. Specifically, surgeons should be aware of risk factors that are potentially associated with dissatisfaction and revision.
  
  
  METHODS
  4.
authors.affiliation: Grand Rapids Medical Education and Research Center/Michigan State University in Grand Rapids, MI 49503, USA.
authors.forename: Keith C
authors.initials: KC
authors.lastname: Neaman
authors.forename: Adam K
authors.initials: AK
authors.lastname: Boettcher
authors.forename: Viet H
authors.initials: VH
authors.lastname: Do
authors.forename: Corlyne
authors.initials: C
authors.lastname: Mulder
authors.forename: Marissa
authors.initials: M
authors.lastname: Baca
authors.forename: John D
authors.initials: JD
authors.lastname: Renucci
authors.forename: Douglas L
authors.initials: DL
authors.lastname: VanderWoude
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000009:adverse effects / Q000379:methods*; D012307:Risk Factors