Dissatisfaction with the symmetry of the nose tip is the top reason that a rhinoplasty patient considers getting a second nose surgery, according to a new study. Between 5 percent to 15 percent of nose surgery patients want revision surgery, according to Dr. Kathy Yu, of Columbia College and Cornell University, New York and one of the authors of the report. Dr. Yu and her colleagues had 104 patients who were seeking nose revision surgery in 2008 and 2009 fill out a questionnaire that asked them why they wanted the second nose surgery. The top three reasons were:
  1. Nose tip asymmetry
  2. Difficulty breathing or nasal obstruction
  3. A crooked middle third of the nose
A surgeon who examined the participants had slightly different findings, which suggests that communication about nasal aesthetics could be improved, according to the study. The surgeon reported three primary aesthetic reasons for revision: tip asymmetry, a crooked middle third and irregularities in the upper third of the nose. The authors said the discrepancy between patient concerns and surgeon findings arose for a variety of reasons.  "One of the main reasons is the surgeon's use of a conventional set of anatomical boundaries, specifically regarding the upper vs. middle third of the nose. Patients often do not have intricate knowledge of nasal anatomy to properly distinguish between nasal thirds," wrote the authors. Of the 64 patients (62 percent) who reported breathing problems or other nasal obstruction issues, the surgeon confirmed problems in 60 of those patients (94 percent). The findings “emphasize the importance of physician awareness of patients' concerns, understanding the causes of post-surgical nasal obstruction and clearly explaining nasal aesthetics to patients seeking revision rhinoplasty," concluded the researchers. “Functional and Aesthetic Concerns of Patients Seeking Revision Rhinoplasty” appears in the September/October issue of the journal Archives of Facial Plastic Surgery.