title: Presenting concerns and surgical management of secondary rhinoplasty.
abstract: BACKGROUND
  Secondary rhinoplasty is a challenging surgical procedure, and patients seeking this procedure tend to be difficult to please. However, psychological and functional improvements in patients and high satisfaction rates are achievable with secondary rhinoplasty.
  
  
  OBJECTIVE
  The authors reviewed a series of secondary rhinoplasties and tabulated patient concerns, underlying deformities, and corrective surgical procedures.
  
  
  METHODS
  The authors conducted a retrospective review of 109 patients for whom the senior author (B.M.) performed secondary rhinoplasty from 2009 to 2012. Concerns causing the patients to seek surgery and management of the secondary procedures were described.
  
  
  RESULTS
  The mean patient age at time of surgery was 33.2 years (range, 18-61 years), and most patients (71.6%) were women. The mean number of previous procedures was 1.6 (range, 1-8). Chief presenting concerns were asymmetry (36.7%), large tip (24.8%), and breathing difficulties (22.0%). The most common clinical findings were nostril asymmetry (33.9%), septal deviation (32.1%), overresection (26.6%), and tip asymmetry (26.6%).
  
  
  CONCLUSIONS
  Patients seeking secondary rhinoplasty present with various concerns. Preoperative identification of the underlying problems and determination of the techniques required to correct them are important to successful secondary procedures. LEVEL OF EVIDENCE 4: Therapeutic.
authors: Dr Nassab is a cosmetic fellow and Dr Matti is a consultant plastic surgeon at Cromwell Hospital, London, UK.
authors: Reza
authors: R
authors: Nassab
authors: Dr Nassab is a cosmetic fellow and Dr Matti is a consultant plastic surgeon at Cromwell Hospital, London, UK.
authors: Basim
authors: B
authors: Matti
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000601:surgery*; D009666:Nose / Q000002:abnormalities / Q000601:surgery*; D009667:Nose Deformities, Acquired / Q000601:surgery*; D017060:Patient Satisfaction; D012086:Reoperation; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D055815:Young Adult