Preoperative Risk Factors and Surgical Techniques Contributing to Persistent Nasal Axis Deviations and Other Complications Postrhinoplasty: A Systematic Review and Meta-analysis

Abstract Background: Rhinoplasty is a common aesthetic procedure aimed at improving nasal appearance and function. Despite advances, complications such as nasal axis deviation, infection, and patient dissatisfaction persist. Identifying preoperative risk factors and refining surgical techniques is essential to minimize these issues. Objective: This systematic review and meta-analysis aimed to determine key preoperative risk factors and surgical techniques associated with persistent nasal axis deviations and other complications following rhinoplasty. Methodology: A systematic search of PubMed, Scopus, and CINAHL was conducted for studies published between 2017 and 2024. Articles meeting predefined criteria were selected. Data on preoperative risk factors, surgical methods, and postoperative outcomes were extracted and analyzed using Review Manager 5.4 to calculate pooled estimates for complications. Study quality was evaluated with the ROBINS-I tool. Results: Five studies involving 5,134 patients were included. Key risk factors identified were nasal trauma, facial asymmetry, and advanced age (≥40 years). The pooled odds ratio for major complications was 1.62 (95% confidence interval: 1.28–2.04), with substantial heterogeneity ( I 2 = 85.1%, τ² =0.0538, P < 0.0001). Novel techniques, such as the modified spreader flap, showed significant improvements in nasal axis correction and patient satisfaction. Conclusion: Preoperative factors predict postoperative complications, and innovative surgical techniques may enhance outcomes. Further research with larger, diverse cohorts and longer follow-up is needed.