title: Frequency of the preoperative flaws and commonly required maneuvers to correct them: a guide to reducing the revision rhinoplasty rate.
abstract: BACKGROUND
  The purpose of this study was to identify the most common deformities seen preoperatively in secondary rhinoplasty patients and the required surgical maneuvers to correct them.
  
  
  METHODS
  A retrospective chart review of 100 consecutive secondary rhinoplasty patients was performed. Preoperative variables included demographics, prior rhinoplasty data, main aesthetic/functional concerns, and the senior author's physical examination of the nose. Details of the operative maneuvers were reviewed.
  
  
  RESULTS
  The average patient age was 39.2 years. All patients had previous rhinoplasties performed by other surgeons. The most common preoperative complaints were airway occlusion (65 percent), dorsum asymmetry (33 percent), nostril asymmetry (18 percent), and tip asymmetry (14 percent). The most common preoperative nasal deformities seen by the senior author (B.G.) were dorsal asymmetry (65 percent), wide dorsum (47 percent), nostril asymmetry (41 percent), wide alar base (38 percent), and dorsal hump (30 percent). The senior author saw significantly more nasal deformities than the patients themselves, especially in the following areas: dorsal asymmetry (65 percent versus 33 percent; p = 0.0002), wide dorsum (47 percent versus 13 percent; p < 0.0001), nostril asymmetry (41 percent versus 18 percent; p = 0.0003), wide alar base (38 percent versus 6 percent; p < 0.0001), dorsal hump (30 percent versus 9 percent; p < 0.0001), and columella protrusion (25 percent versus 6 percent; p = 0.0002). The most common revision rhinoplasty surgical maneuvers were septoplasty (71 percent), alar rim graft (67 percent), dorsal graft (63 percent), osteotomy (60 percent), and dorsal hump removal (46 percent).
  
  
  CONCLUSIONS
  The high incidence of airway concerns among secondary rhinoplasty patients is alarming and emphasizes the urgent need to pay attention to the airway during primary rhinoplasty. There is often a disparity between what the patient sees and what the surgeon observes.
authors.affiliation: Cleveland, Ohio From the Department of Plastic Surgery, Case Western Reserve University.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lee
authors.forename: Samantha
authors.initials: S
authors.lastname: Zwiebel
authors.forename: Bahman
authors.initials: B
authors.lastname: Guyuron
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061270:Nasal Septal Perforation / Q000209:etiology / Q000601:surgery*; D009300:Nasal Septum / Q000473:pathology / Q000601:surgery; D009666:Nose / Q000033:anatomy & histology / Q000601:surgery; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000009:adverse effects* / Q000379:methods* / Q000706:statistics & numerical data; D055815:Young Adult