Back For More: why patients seek rhinoplasty after septoplasty.

Abstract Objectives This study aimed to determine what motivates rhinoplasty surgery after septoplasty, and the clinical characterisation of patients undergoing these interventions. Methods This is a retrospective observational study including all patients submitted to rhinoplasty after septoplasty between January 2018 and July 2023. Demographic, clinical and surgical data were collected using patients’ digital hospital records. Results Of 219 patients who underwent rhinoplasty, 15 per cent ( n = 33) had a previous history of septoplasty. All patients ( n = 33) who had undergone septoplasty before rhinoplasty reported maintenance of nasal obstruction, with most patients presenting with nasal deformities upon physical examination (54%; n = 18), of which 15 per cent ( n = 5) presented with nasal tip ptosis and with 9 per cent ( n = 3) presenting with nasal septum perforation. The mean interval between septoplasty and rhinoplasty was 77 months. An open approach was used in 58 per cent of patients, and grafts in 73 per cent, most commonly columella struts, with cartilage harvested from the nasal septum in 55 per cent but requiring auricular cartilage in 18 per cent. Conclusion Persistent nasal obstruction is the main indication for rhinoplasty after septoplasty, commonly associated with residual septal deviation, nasal valve dysfunction or external nasal deformities. These findings emphasise the importance of a thorough pre-operative assessment of all nasal structures in patients with nasal obstruction. Rhinoplasty in this context often represents a more complex surgical challenge, frequently requiring an open approach and a greater use of cartilage grafts, sometimes harvested from sites beyond the nasal septum. A comprehensive approach that addresses both functional and aesthetic components during the primary surgery may reduce revision rates, facilitate easier corrective procedures if needed and improve long-term patient satisfaction.