Revision rhinoplasty with free diced cartilage grafts: Outcome evaluations with the Nasal Obstruction Symptom Evaluation (NOSE) scale

Outcome of revision rhinoplasty



revision rhinoplasty, diced cartilage grafts, NOSE scale


Background/Aim: The Nasal Obstruction Symptom Evaluation (NOSE) scale is a validated, reliable, and feasible instrument used to evaluate nasal obstruction severity. We aimed to assess patient satisfaction using the NOSE score after revision rhinoplasty with free diced cartilage (fDC) grafts.

Methods: In this cross-sectional study, 36 patients who underwent a revision rhinoplasty procedure completed the Turkish version of the NOSE questionnaire before and six months after rhinoplasty. Pre- and postoperative NOSE scores were compared using the Mann Whitney U test.

Results: The pre- and postoperative total mean NOSE scores were 68.06 and 8.47, respectively. The NOSE score significantly decreased six months after rhinoplasty surgery (P<0.001). Adapting to exercise was the parameter with the highest improvement rate.

Conclusion: The outcome of the NOSE questionnaires in patients with nasal deformities shows that a revision rhinoplasty surgery with the placement of fDC grafts contributes to the improvement of nasal functions. The Turkish version of the NOSE scale is a useful tool to assess patient satisfaction among the Turkish population.


Download data is not yet available.


Daniel RK. The Preservation Rhinoplasty: A New Rhinoplasty Revolution. Aesthet Surg J. 2018 Feb 17;38(2):228-9. doi: 10.1093/asj/sjx258. DOI:

Elsayed M, Alghamdi AS, Khan M, et al. Causes, Prevention, and Correction of Complications of Primary and Revision Septorhinoplasty. Cureus. 2021 Dec 21;13(12):e20557. doi: 10.7759/cureus.20557. DOI:

Loghmani S, Loghmani A, Maraki F. Secondary Rhinoplasty: Aesthetic and Functional Concerns. Plast Surg (Oakv). 2019 Aug;27(3):217-22. doi: 10.1177/2292550319828799. DOI:

Sibar S, Findikcioglu K, Pasinlioglu B. Revision Rhinoplasty after Open Rhinoplasty: Lessons from 252 Cases and Analysis of Risk Factors. Plast Reconstr Surg. 2021 Oct 1;148(4):747-57. doi: 10.1097/PRS.0000000000008318. DOI:

Nasser NA. Rhinoplasty. In: Bonanthaya K, Panneerselvam E, Manuel S, Kumar VV, Rai A. (eds) Oral and Maxillofacial Surgery for the Clinician. Springer, Singapore. 2021 doi: 10.1007/978-981-15-1346-6_38 DOI:

Nassab R, Matti B. Presenting concerns and surgical management of secondary rhinoplasty. Aesthet Surg J. 2015 Feb;35(2):137-44. doi: 10.1093/asj/sju026. DOI:

Kim JH, Ko HS, Park SW. Using Dermofat Grafting in Revision Rhinoplasty. Aesthetic Plast Surg. 2021 Apr;45(2):617-25. doi: 10.1007/s00266-020-01950-5. DOI:

Wong BJF, Friedman O, Hamilton GS 3rd. Grafting Techniques in Primary and Revision Rhinoplasty. Facial Plast Surg Clin North Am. 2018 May;26(2):205-23. doi: 10.1016/j.fsc.2017.12.006. DOI:

Xiao H, Zhao Y, Liu L, Xiao M, Qiu W, Liu Y. Functional/Aesthetic Measures of Patient Satisfaction After Rhinoplasty: A Review. Aesthet Surg J. 2019 Sep 13;39(10):1057-62. doi: 10.1093/asj/sjz029. DOI:

Yang F, Liu Y, Xiao H, et al. Evaluation of Preoperative and Postoperative Patient Satisfaction and Quality of Life in Patients Undergoing Rhinoplasty: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2018 Mar;141(3):603-11. doi: 10.1097/PRS.0000000000004102. DOI:

Ansari E, Rogister F, Lefebvre P, et al. Responsiveness of acoustic rhinometry to septorhinoplasty by comparison with rhinomanometry and subjective instruments. Clin Otolaryngol. 2019 Sep;44(5):778-83. doi: 10.1111/coa.13394. DOI:

van Zijl FVWJ, Timman R, Datema FR. Adaptation and validation of the Dutch version of the nasal obstruction symptom evaluation (NOSE) scale. Eur Arch Otorhinolaryngol. 2017 Jun;274(6):2469-76. doi: 10.1007/s00405-017-4486-y. DOI:

Karahatay S, Taşlı H, Karakoç Ö, et al. Reliability and validity of the Turkish Nose Obstruction Symptom Evaluation (NOSE) scale. Turk J Med Sci. 2018 Apr 30;48(2):212-6. doi: 10.3906/sag-1509-81. DOI:

Kreutzer C, Hoehne J, Gubisch W, et al. Free Diced Cartilage: A New Application of Diced Cartilage Grafts in Primary and Secondary Rhinoplasty. Plast Reconstr Surg. 2017 Sep;140(3):461-70. doi: 10.1097/PRS.0000000000003622. DOI:

Rezaei F, Rezaei F, Abbasi H, et al. A Comparison of Doctor/Patient Satisfaction with Aesthetic Outcomes of Rhinoplasty: a Prospective Study. J Med Life. 2019 Oct-Dec;12(4):374-80. doi: 10.25122/jml-2019-0061. DOI:

Zojaji R, Sobhani E, Keshavarzmanesh M, et al. The Association Between Facial Proportions and Patient Satisfaction After Rhinoplasty: A Prospective Study. Plast Surg (Oakv). 2019 May;27(2):167-72. doi: 10.1177/2292550319826097. DOI:

Gerecci D, Casanueva FJ, Mace JC, et al. Nasal obstruction symptom evaluation (NOSE) score outcomes after septorhinoplasty. Laryngoscope. 2019 Apr;129(4):841-6. doi: 10.1002/lary.27578. DOI:

Rhee JS, Sullivan CD, Frank DO, et al. A systematic review of patient-reported nasal obstruction scores: defining normative and symptomatic ranges in surgical patients. JAMA Facial Plast Surg. 2014 May-Jun;16(3):219-25; quiz 232. doi: 10.1001/jamafacial.2013.2473. DOI:

Mondina M, Marro M, Maurice S, et al. Assessment of nasal septoplasty using NOSE and RhinoQoL questionnaires. Eur Arch Otorhinolaryngol. 2012 Oct;269(10):2189-95. doi: 10.1007/s00405-011-1916-0. DOI:

Dinesh Kumar R, Rajashekar M. Comparative Study of Improvement of Nasal Symptoms Following Septoplasty with Partial Inferior Turbinectomy Versus Septoplasty Alone in Adults by NOSE Scale: A Prospective Study. Indian J Otolaryngol Head Neck Surg. 2016 Sep;68(3):275-84. doi: 10.1007/s12070-015-0928-2. DOI:

Saratziotis A, Emanuelli E, Zanotti C, et al. Endoscopic sinus surgery outcomes in CRS: quality of life and correlations with NOSE scale in a prospective cohort study. Eur Arch Otorhinolaryngol. 2021 Apr;278(4):1059-66. doi: 10.1007/s00405-020-06334-8. DOI:

Alsubeeh NA, AlSaqr MA, Alkarzae M, et al. Prevalence of considering revision rhinoplasty in Saudi patients and its associated factors. Maxillofac Plast Reconstr Surg. 2019 Dec 10;41(1):59. doi: 10.1186/s40902-019-0237-x. DOI:

Kotzampasakis D, Delistathi T, Kotzampasakis S, et al. Aesthetic Rhinoplasty and Nasal Obstruction: Presentation of Results of a 100-Patient Study by Using NOSE Inventory. Aesthetic Plast Surg. 2019 Apr;43(2):428-36. doi: 10.1007/s00266-019-01316-6. DOI:

Taş S. Ultra Diced Cartilage Graft in Rhinoplasty: A Fine Tool. Plast Reconstr Surg. 2021 Apr 1;147(4):600e-6e. doi: 10.1097/PRS.0000000000007794. DOI:

Bullocks JM, Echo A, Guerra G, et al. A novel autologous scaffold for diced-cartilage grafts in dorsal augmentation rhinoplasty. Aesthetic Plast Surg. 2011 Aug;35(4):569-79. doi: 10.1007/s00266-011-9725-9. DOI:

Brenner KA, McConnell MP, Evans GR, et al. Survival of diced cartilage grafts: an experimental study. Plastic and Reconstructive Surgery. 2006 Jan;117(1):105-15. doi: 10.1097/01.prs.0000195082.38311.f4. DOI:

Bezerra TF, Padua FG, Pilan RR, et al. Cross-cultural adaptation and validation of a quality of life questionnaire: the Nasal Obstruction Symptom Evaluation questionnaire. Rhinology. 2011 Jun;49(2):227-31. doi: 10.4193/Rhino10.019. DOI:

Shukla RH, Nemade SV, Shinde KJ. Comparison of visual analogue scale (VAS) and the Nasal Obstruction Symptom Evaluation (NOSE) score in evaluation of post septoplasty patients. World J Otorhinolaryngol Head Neck Surg. 2020 Apr 6;6(1):53-8. doi: 10.1016/j.wjorl.2019.06.002. DOI:

Khan N, Rashid M, Khan I, et al. Satisfaction in Patients After Rhinoplasty Using the Rhinoplasty Outcome Evaluation Questionnaire. Cureus. 2019 Jul 30;11(7):e5283. doi: 10.7759/cureus.5283. DOI:






Research Article

How to Cite

Kandulu H. Revision rhinoplasty with free diced cartilage grafts: Outcome evaluations with the Nasal Obstruction Symptom Evaluation (NOSE) scale: Outcome of revision rhinoplasty. J Surg Med [Internet]. 2023 Oct. 27 [cited 2024 Jul. 15];7(10):700-4. Available from: