Presenting concerns and surgical management of secondary rhinoplasty.

[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.

[OBJECTIVES] 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.