Differences between Primary and Revision Rhinoplasty: Indications, Techniques, Grafts, and Outcomes.

Abstract

We read with great interest the article entitled “Differences between Primary and Revision Rhinoplasty: Indications, Techniques, Grafts, and Outcomes,” by Stefan Hacker et al..1 In recent years, there has been a sharp increase in the number of rhinoplasty procedures performed, especially among Asians. Then again, there are more and more revision surgical procedures being performed. We would like to thank the authors for their essential analysis. In their study, Hacker et al. retrospectively evaluated 245 patients in 153 primary cases and 92 revision cases. We agree with the authors that most patients undergoing revision sought surgery for aesthetic and functional reasons, and revision surgery requires more complex techniques and extranasal grafts. Nevertheless, there are some points that we would like to comment on that may be worth further discussion. On the one hand, the authors describe the specific reasons for primary and revision surgery in their Table 2, but the previously detailed operative information was not described for patients undergoing revision. What surgical steps did they take? Did they use implants, nasal grafts, or extranasal grafts? In the current literature, most revisions are associated with alloplastic implants, such as silicone and expanded polytetrafluoroethylene.2 There is no exception in our center. On the other hand, the authors conclude that the rate of another revision during the follow-up period was significantly higher after revision surgery than after primary rhinoplasty. In our center, however, almost every patient underwent costal cartilage–based augmentation rhinoplasty, which is the departmental standard.3,4 Because of scar tissue, destruction of nasal anatomy, and additional bleeding, the revision procedures would take longer than the primary ones. During follow-up, there was no significant difference in another revision surgery between primary and revision procedures.3,4 If there is no warping of costal cartilage, few patients will choose to undergo another operation. This probability is the same for the primary and revision patients. However, most postoperative infections occurred in revision patients, especially those with a history of nose infection, as summarized in our upcoming article. The authors did not include the infection rate, which is another reason for revision. In addition, the authors performed diced cartilage rhinoplasty. It has been reported that wrapped grafts tend to taper at the upper and lower edges and grafts have a certain probability of absorption, especially auricular cartilage.5 It would be interesting for us to know the outcome. We would like to thank the authors for their study and for sharing their valuable experiences with us. Xin Wang, M.D.Wenfang Dong, M.D.Fei Fan, M.D.Department of RhinoplastyPlastic Surgery HospitalChinese Academy of Medical Sciences andPeking Union Medical CollegeBeijing, People’s Republic of China