Methods/Technique: We identified 100 consecutive secondary patients, 50 who originally had dorsal humps and 50 who had straight noses. The straight nose patients were segregated by their original motivations for surgery. Catalogued were age, gender, marital status, the number of prior rhinoplasties, the number of other aesthetic operations, whether the patients were “high maintenance” (demanding extra surgeon or staff time), history of trauma or abuse (from direct surgeon-patient interview), and satisfaction with the surgical outcome. Fisher’s exact test assessed equality of proportion; Wilcoxon rank-sum test measured differences in prior surgery prevalence; multinomial logistic regression tested association between various parameters and trauma or satisfaction with the surgical result.
Results/Complications: The entire group was 14% male, 86% female. Compared to those patients who originally had dorsal humps, straight nose patients were older (45 vs. 37 years), had undergone more rhinoplasties (4.9 vs. 1.7), more other aesthetic operations (6.3 vs. 2.1), were more likely to be high maintenance (72% vs. 32%), more likely to have a history of interpersonal or childhood trauma (66% vs. 26%), and less likely to consider my surgery a success that did not require further revision (all p< 0.001 or less).
The straight nose patients fell almost evenly into two groups: those who originally had airway obstruction or 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).
Of the entire cohort of 100, those patients who had undergone >4 cosmetic operations were more likely to request additional nasal surgery (74% vs. 47%) than those who had undergone <4 cosmetic operations, and were also more likely to have a trauma history (64% vs. 29%).
Conclusion: Patients who originally had straight noses differ from those who had dorsal humps. In particular, they are more likely to have had other aesthetic surgery, more likely to require extra surgeon and staff time, more likely to have an interpersonal or childhood trauma history, and less likely to be happy with the result of another rhinoplasty.
Two noteworthy patterns emerged in the 100 patient group: (1) Those patients who were high maintenance, had multiple surgeries, and a history of interpersonal trauma had a 66% chance of wanting more nasal surgery, which increased to 74% in patients who had undergone >4 prior cosmetic operations, and to 85% if the original goal was a “more perfect nose.” (2) Those patients who were high maintenance, had multiple surgeries, and requested additional surgery had a 76% prevalence of prior interpersonal trauma (88% for those originally motivated to have a “more perfect nose”).
There appears to be an association between interpersonal trauma, plastic surgical “addiction”, and perceived surgical success.