Revision Rhinoplasty: Reducing Complications in Rhinoplasty

Box1. Nasal analysis

General
Skin quality: integrity, vascularity, mobility, skin thickness (thin, medium, or thick)

Identify primary concerns leading patient to seek rhinoplasty (eg, "big," "twisted," "large hump")

Frontal view
Twisted or straight: follow brow-tip esthetic lines Width: narrow, wide, normal, "wide-narrow-wide" Tip: deviated, bulbous, asymmetric, amorphous, other

Baseview
Triangularity: good versus trapezoidal
Tip: deviated, wide, bulbous, bifid, asymmetric
Base: wide, narrow, or normal; inspect for caudal septal deflection
Columella: columellar-to-lobule ratio (normal is 2:1 ratio); status of medial crural footplates

Lateralview
Nasofrontal angle: shallow or deep
Nasal starting point: high or low
Dorsum: straight, concavity, or convexitydbony, bony-cartilaginous or cartilaginous (ie, is convexity primarily bony, cartilaginous, or both)
Nasal length: normal, short, long
Tip projection: normal, decreased, or increased
Alar-columellar relationship: normal or abnormal
Nasolabial angle: obtuse or acute

Obliqueview
Does it add anything, or does it confirm the other views
There are many other points of analysis that can be made on each view, but these are some of the vital points of commentary.

After completing the general assessment, the most striking characteristics of the nose should be noted and highlighted. These are typically the characteristics that bring the patient for rhinoplasty, such as excessive size, deviation, or a dorsal hump. These primary patient concerns must be recognized, highlighted, and addressed above all else.

As the surgeon reviews each photographic image, the major esthetic and technical points are noted first. Next, subtleties in analysis are addressed. It is important to recognize the characteristics of greatest concern to the patient and the more subtle findings. The patient may not notice these other subtle abnormalities if they are left unaddressed by the surgeon. Postoperatively, the scrutinizing patient may notice and point out these abnormalities. Stepwise, methodical analysis of the patient and the photographic views allows a well-trained surgeon to identify significant anatomic and esthetic points.

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Ask Dr. Becker a question about revision rhinoplasty or make an appointment for a consultation, by calling 856-589-NOSE (6673) or emailing us at info@revisionrhinoplasty.com.

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