Identifying High-Risk Unhappy Patients in Secondary Rhinoplasty

Goals/Purpose: Trauma affects body image. What effect does a trauma history have on satisfaction after secondary rhinoplasty?

Methods/Technique: Records were reviewed of 100 consecutive secondary patients on whom I had operated.  Catalogued were age, gender, marital status, no. prior rhinoplasties and other aesthetic operations, whether the patients were “high maintenance”, surgical motivation, original nasal shape, history of neglect or abuse from direct surgeon interview, and satisfaction with the outcome. Fisher’s exact test assessed equality of proportion; Wilcoxon rank-sum test measured differences in parameters; multinomial logistic regression tested association between parameters and trauma/satisfaction with the result.

Results/Complications: The group was 14% male, 86% female. Compared to patients without a childhood trauma history, patients with such a history were older (45 vs. 35 years), had undergone more rhinoplasties (4.3 vs. 2.3), more other aesthetic operations (5.7 vs. 2.4), were more likely to be “high maintenance” (82% vs. 11%), and less likely to consider my surgery a success that did not require further revision (13 vs. 69%), (all p< 0.001 or less).  

Fifty patients originally had straight noses; 50 had dorsal humps.  The 50 straight nose patients fell almost evenly into two groups: those who had airway obstruction/asymmetry (24 patients), and those who wanted “more perfect” noses (26 patients).  The “more perfect nose” patients were all women, and (in comparison to the other straight nose patients) had undergone more rhinoplasties (5.3 vs. 4.4, ns), more other aesthetic surgeries (7.5 vs. 5.0), were more likely to be “high maintenance” (96% vs. 41%), had a higher prevalence of interpersonal trauma history (88% vs. 42%), and were more likely to be dissatisfied with the result and request another surgery (85% vs. 54%) (all p < 0.001).

The patient type most likely to be satisfied postoperatively was male, originally had dorsal hump, was low maintenance, had undergone no other cosmetic operations, and had no trauma history (satisfaction rate: 100%). The patient least likely to be satisfied postoperatively was female, originally had a straight nose but wanted a “more perfect nose”, was high maintenance, had undergone multiple other cosmetic operations, and had a positive trauma history (satisfaction rate: 13%).

Conclusion: There appears to be an association between nasal shape, plastic surgical “addiction”, interpersonal trauma, and perceived surgical success in secondary rhinoplasty.