Is it true that people have revisionary rhinoplasty are often demanding and difficult? A recent report in the September issue of Plastic and Reconstructive Surgery seems to undermine that old stereotype. The author of the report, Mark Constantian, MD, found that 97% of revisionary rhinoplasty patients were satisfied with their new results – and questions whether body dysmorphic disorder (BDD) is as common among these patients as previously assumed.
Dr. Constantian’s report examines his own experiences of 150 secondary procedures. These revisionary rhinoplasties, which took place from 2007 to 2008, involved 121 women and 29 men. The patients underwent between one and eight surgeries, with an average of 3.6 per patient.
Why have revisionary rhinoplasty?
- 41 percent of Dr. Constantian’s patients had revisionary rhinoplasty because of new deformities that they wanted corrected
- 33 percent felt that the first rhinoplasty had failed to correct the original deformity
- 15 percent felt that they had lost “personal, familial, or ethnic characteristics” in their noses
- 1 percent had new or continuing problems with obstructed airflow
Unreasonable? Based on these results, Dr. Constantian concluded that “the majority (90 percent) sought surgery to correct residual or new deformities, to restore personal characteristics than had been lost, or to correct functional complaints… To these patients, the first operation had either been wasted or had done harm.” He judged that only 10 percent of patients were seeking further improvement on an “already acceptable result.”
Demanding and difficult? Dr. Constantian and his staff found that only 14 percent of the patients could be considered demanding. Roughly 20 percent were judged to have possible depression. Once their surgeries were completed, he found that 97 percent of patients were happy with their results.
Body dysmorphic disorder? BDD is a psychiatric disorder in which patients are so concerned about their physical appearance that it interferes with their daily lives. Only three of Dr. Constantian’s 150 patients – a small minority – met the psychological criteria for body dysmorphic disorder. As a result, Dr. Constantian cautions against stereotyping revisionary rhinoplasty patients. In most cases, people want revisionary procedures for legitimate reasons.