What motivates secondary rhinoplasty? A study of 150 consecutive patients.

Background: There is little evidence-based information on secondary rhinoplasty patient motivations for surgery, satisfaction, or revision rates.
Methods: The charts of 150 consecutive patients (121 women and 29 men) who underwent secondary rhinoplasty between July of 2007 and October of 2008 were reviewed; preoperative deformity severity was graded from 1 to 5. The patients' primary reasons for surgery, patient and surgeon satisfaction, and postoperative depression or body dysmorphic disorder were tallied.
Results: The average number of prior operations was 3.6. The most commonly expressed reason (41 percent) for undergoing revision was the development of a new deformity after the primary rhinoplasty. Those patients also had the most severe preoperative deformities (p < 0.02). Other motivations were failure to correct the original deformity (33 percent), an intolerable perceived loss of personal, familial, or ethnic characteristics (15 percent), the desire for further improvement in an already acceptable result (10 percent), and a new or unrelieved airway obstruction (1 percent). Ninety-seven percent of patients were happy with their outcomes. Forty patients (27 percent) were depressed before surgery and three (2 percent) displayed evidence of body dysmorphic disorder postoperatively. The depressed and dysmorphic patients did not have worse deformities than those who were not depressed postoperatively (p < 0.8695).
Conclusions: Most secondary rhinoplasty patients have motivations similar to those of our other reconstructive patients and will be pleased with their surgical outcomes. The most severe preoperative deformities were iatrogenic. The unhappy postoperative patients, including those with body dysmorphic disorder, did not have more severe preoperative deformities than the others (i.e., their deformities alone did not justify their unhappiness).