Analyses and classification of complexities in rhinoplasties based on factors increasing the difficulty and their appropriate reconstruction.

[OBJECTIVES] This study aims to classify the factors that make rhinoplasty difficult and appropriate reconstruction of it.

[PATIENTS AND METHODS] We retrospectively evaluated the records of 103 patients who underwent rhinoplasty at our private clinic between April 2002 and December 2014. The most important reagent affecting the degree of difficulty in our study was the adhesion of the bone and cartilaginous structures to the skin and mucosa, as an outcome of on previous operations. Structural deficiencies in various parts of bone and cartilaginous structures, presence of septum deviation at a very advanced level, asymmetries in the lower and upper lateral cartilages, fracture deformities or trauma-related bone compressions, skin quality and thickness and the age of the patient were other criteria that affected the degree of difficulty of rhinoplasty. Taking these compelling factors into consideration, a difficulty coefficient table was set up with a new classification that determines complexity and suggests appropriate reconstructions.

[RESULTS] The total of difficulty coefficients of rhinoplasties between 1-3 were considered to be less complex, those between 4-6 as intermediate complex and those being >7 as very complex rhinoplasty.

[CONCLUSION] Calculation of the difficulty coefficient provides objective determination of the degree of difficulty of the operation. Reconstruction plans, probable duration of surgery, preoperative preparations, all grafts and materials considered for use may be predicted according to the difficulty coefficient. The surgeon can test whether his or her experience is sufficient or not according to the difficulty coefficient. Surgical risks can be assessed in the light of the difficulty coefficient and shared with the patient.