Predicting the results of rhinoplasty before surgery: Easy noses versus difficult noses

Abstract

A major problem for many rhinoplastic surgeons is the ability to predict, before surgery, the difficulty of the procedure (whether the rhinoplasties will be technically easy or technically difficult to perform) and the success rate of the result (whether the rhinoplasty will likely give good results or poor ones).The present paper outlines a systematic approach to nasal analysis, allowing the surgeon to consistently estimate, before surgery, the degree of technical difficulty of each rhinoplasty, as well as predicting its future result in terms of patient satisfaction. This preoperative evaluation is based on the analysis of the skin texture and the osteocartilagenous framework on lateral and frontal views. It allows for the nose to be classified as green (easy), yellow (moderate) or red (difficult), depending on two factors: the degree of surgical difficulty and the expected patient's satisfaction with the result.The essence of the present paper is to introduce a simple, systematic approach to assist the novice rhinoplastic surgeon to assess the complexity, the risks and the expected outcome of a rhinoplasty in the preoperative period, rather than postoperatively.

Keywords: Difficult; Easy; Predicting results; Rhinoplasty.

Figure 1)

Simplified illustration for the green / yellow / red light nose classification. (Note: a free, plastified, coloured illustration is available for teaching purposes, by contacting the authors)

Figure 2)

Examples of ‘red light’ noses. Patient 1: (A and B) Preoperative photographs of a 37-year-old man with a severe pyramid deformity, classifying it as a red light nose, even if he had a prominent hump (which he does not); (C and D) postoperative results 11 months later. Patient 2: (E and F) Preoperative photographs of a 18-year-old woman with a severe tip deformity and marked pyramid deviation, both classifying her into the red light category, in spite of her prominent hump; (G and H) postoperative results six months later. Patient 3: (I and J) Preoperative photographs of a 19-year-old woman with a saddle dorsum deformity; (K and L) postoperative results five years (62 months) later

Figure 3)

Examples of ‘green light’ noses. Patient 1: (A and B) Preoperative photographs of a 19-year-old man with a prominent dorsal hump, without any other significant nasal deformities; (C and D) postoperative results 12 months later. Patient 2: (E and F) Preoperative photographs of a 25-year-old woman with a significant hump and a mild tip deformity; (G and H) postoperative results more than four years (52 months) later

Figure 4)

Example of a ‘yellow light’ nose, in between a ‘green light’ and a ‘red light’ nose, but closer to a green light one. A and B Preoperative pictures of a 54-year-old woman with a moderate hump and a mild tip problem; C and D Postoperative results 2.5 years (30 months) later