If, according to one professional organization of plastic surgeons, a quarter of all first rhinoplasties do not please the patient or are somehow botched, what could be in the minds of patients who want a revision rhinoplasty?


Plastic surgeon Mark Constantian, M.D. of Saint Joseph Hospital in Nashua, New Hampshire, wondered the same thing and organized a study to find out. The results are printed in the 9-’12 issue of Plastic and Reconstructive Surgery, an official plastic surgery journal, read by cosmetic plastic surgeons worldwide.


So Dr. Constantian studied the medical records of 150 patients who sought and had revision nose jobs.


Until now, most plastic and cosmetic surgeons considered patients who wanted a revision rhinoplasty hard to get along with, demanding or difficult during the consultation and surgical process.


But that finding may not be accurate.


Dr. Constantian knows because he also performed revision surgery on the 150 patients during a year and one-half period stretching from 2007 to 2008.


During the study, the doctor carefully looked at the reasons given by the patients for wanting the do-over surgery, any personality management problems caused by the study group along with the surgeon’s and the patients’ happiness over the outcome of the surgeries as revealed by the nose job before and after pictures.


The doctor studied 121 women and 29 men; the study group was an average of 42 years old.


Remember we said that first rhinoplasties were often botched? Dr. Constantian found the patients had undergone one to eight previous nasal surgeries with an average of 3.6 nose jobs per patient.


His findings? Let him tell it: “The reasons for wanting a revision surgery are about the same as people who want a first rhinoplasty – to look good and to have a botched nose reconstructed.”


Added the plastic surgeon: “My experience as a surgeon doing surgery on these 150 patients really questions the idea that patients who want a revision surgery are hard to get along with.”


But not all the revision surgeries were due to fumble-thumb surgeons.


A full 41 percent who wanted a fix-it nose job was to straighten out a new deformity. For instance, a nose that was once straight had become crooked. In about one-third of the patients, a first nose job did not correct an original deformity.


Another 15 percent of the study group thought their noses had lost the personal, family or racial marks that so well defined them.


One percent had new or continuing woes with breathing and obstruction of healthy airflow through the nose.


Only 10 percent wanted more improvement in a nose that could not be improved any more by surgery.


The score for Dr. Constantian’s group of 150? 97 percent were happy with the way their noses looked after surgery.


All that underscores the concept that a first rhinoplasty is the most difficult of all plastic surgeries so a master rhinoplasty surgeon is required for a revision rhinoplasty.