Abstract
Background: This study aimed to investigate clinical, procedural, and expectation-related factors associated with severe postoperative dissatisfaction following septorhinoplasty and to evaluate the contribution of surgical specialty. Methods: This retrospective study included 223 adult patients referred for medico-legal evaluation because of clinically significant dissatisfaction after primary septorhinoplasty performed between 2018 and 2022. Variables included complication patterns, Surgical Complexity Score, Expectation Alignment Score, revision demand, and health care utilization indicators. A primary multivariable logistic regression model was constructed to identify factors independently associated with severe dissatisfaction; revision demand was analyzed descriptively as a postoperative marker of dissatisfaction burden. Results: In the primary multivariable logistic regression model, combined functional–aesthetic complications (odds ratio [OR] = 2.9, 95% CI: 1.6-5.3, P = .001) and higher Surgical Complexity Score (OR = 1.8 per unit increase, 95% CI: 1.3-2.5, P = .003) were independently associated with severe dissatisfaction. Surgical specialty was not independently associated with severe dissatisfaction (OR = 1.5, 95% CI: 0.8-2.7, P = .12). Revision demand was frequent among patients with severe dissatisfaction but was interpreted as a marker of dissatisfaction burden rather than as an independent predictor. Conclusion: Severe postoperative dissatisfaction following septorhinoplasty is multifactorial and is primarily associated with combined complication patterns and procedural complexity rather than surgical specialty alone. Revision demand should be interpreted as a postoperative marker of dissatisfaction burden. Identification of high-risk patients may improve preoperative counseling and optimize surgical outcomes.