When Revision Rhinoplasty Is Considered
Patients come to me for revision rhinoplasty for various reasons. Sometimes it's dissatisfaction with the cosmetic result of a previous procedure. Sometimes it's a functional issue like persistent breathing difficulty. And sometimes it's both.
Common reasons for considering revision include:
- Persistent asymmetry that wasn't corrected
- Over-reduction creating a pinched or unnatural appearance
- Under-correction leaving the original problem partially unaddressed
- Breathing problems that weren't resolved or that developed after surgery
- Collapse of nasal structures over time
- New deformities appearing as healing progressed
Whatever your reason, the first step is a thorough consultation to understand exactly what's happened and what can realistically be achieved.
The Importance of Your Previous Operation Notes
Here's something that might seem unusual: before we can fully plan your revision surgery, I need to know what happened during your original operation.
When you contact your previous surgeon's office (or the hospital where you had your surgery), ask for a copy of your medical records, specifically the operation notes. This document describes exactly what the surgeon did, what structures were modified, what cartilage was removed, what grafts were placed.
Why does this matter so much?
Imagine trying to renovate a house without knowing what the previous builders did. Did they move a load-bearing wall? Did they install new plumbing? What's hiding behind the walls? Without that information, you're working blind.
The same principle applies to revision rhinoplasty. If your previous surgeon removed significant cartilage from your septum, I need to know that because:
- It tells me what structural support remains
- It tells me what cartilage is available if I need grafts
- It helps me predict what I'll find when I operate
If the previous surgery was just a septoplasty for breathing and didn't involve the tip or dorsum, that's valuable information too. It tells me that certain structures haven't been touched and will be easier to work with.
The Waiting Period
Rhinoplasty healing is a slow process. Swelling can persist for up to a year, and subtle changes continue even after that. Scar tissue forms and matures over many months.
For this reason, we typically recommend waiting at least 12 months after a primary rhinoplasty before considering revision. Operating too soon means:
- The nose hasn't finished healing from the first surgery
- Swelling may be masking the true result
- Scar tissue is still active and changing
- Results are less predictable
There are exceptions. If the revision will be in a completely different area than the original surgery (for example, if your first operation was purely functional and the revision is purely cosmetic to the tip), the waiting period may be shorter.
During your consultation, I'll assess where you are in the healing process and advise on timing.
What I'm Looking For During Examination
When I examine you, I'm trying to correlate what I see externally with what I know (or don't know) about the internal structure.
I'll assess:
External Appearance
What's the current shape? Is there asymmetry? Is the tip too pinched, too wide, droopy, or over-rotated? Is there a residual hump or has too much been taken?
Structural Integrity
How do the cartilages feel? Are they intact, or does the tip feel weak and floppy? Is there clicking or movement that shouldn't be there? Can I feel cartilage edges that suggest previous grafting?
Breathing Function
Can you breathe through both sides? Is there obstruction? Has the septum been addressed or is there deviation remaining?
Skin Quality
How thick is the skin? Thick skin can hide some structural issues but also limits how much refinement is visible. Previous surgery may have created scar tissue that affects skin mobility.
When Cartilage Grafts Are Needed
Revision rhinoplasty often requires cartilage grafts to rebuild or support nasal structures. The question is: where will that cartilage come from?
Septal Cartilage
The first choice is usually the nasal septum. It's the ideal material and it's convenient. But if significant septal cartilage was removed during your previous surgery, there may not be enough left.
Ear Cartilage
The ear is an excellent backup source. I can take cartilage from behind the ear (through a hidden incision) or from the bowl of the ear. The ear recovers well and the scar is hidden. This is a common approach in revision cases.
Rib Cartilage
For major reconstructions where large amounts of cartilage are needed, rib cartilage may be required. This involves an additional incision on the chest and a slightly longer recovery. It's reserved for the most complex cases.
During your consultation, I'll discuss which source is likely to be needed for your specific situation.
Open vs Closed Approach in Revision
I generally prefer closed rhinoplasty for both primary and revision cases. However, revision surgery sometimes requires open approach when:
- The tip cartilages need extensive reshaping
- There's significant scar tissue distorting the anatomy
- Complex grafting is required
- I need maximum visibility to understand what was done before
If the revision is straightforward, for example addressing a specific cartilage that's clicking or adjusting a minor asymmetry, closed approach is often still appropriate.
I'll recommend the approach I think gives you the best chance of a good outcome for your specific situation.
Managing Expectations
This is perhaps the most important part of the consultation. Revision rhinoplasty is inherently more challenging than primary rhinoplasty. Here's what you should understand:
Results Are Less Predictable
Scar tissue from previous surgery makes the nose less responsive to surgical manipulation. The cartilages may be weaker. The blood supply may be compromised. All of this means results are harder to predict than in a nose that's never been operated on.
Perfect Symmetry Is Unlikely
The goal is improvement, not perfection. Some asymmetry or irregularity may persist even after revision. If minor imperfections exist, they may not justify the risks of another surgery.
Multiple Revisions Have Diminishing Returns
Each surgery creates more scar tissue and potentially weakens structures further. While a single revision can often achieve significant improvement, multiple revisions become progressively more challenging.
There's Always Some Risk
Revision rhinoplasty carries all the standard risks of rhinoplasty (infection, bleeding, asymmetry, breathing changes, need for further surgery) plus additional risks related to operating on previously operated tissue.
The Consultation Process
For revision rhinoplasty, I often recommend an initial consultation followed by a second consultation once I've reviewed your previous operation notes.
First consultation: I'll examine you, discuss your concerns, take photographs, and ask about your previous surgery. I'll advise you on obtaining your operation notes.
Second consultation (once notes are received): With the full picture, I can give you a more complete assessment of what's achievable and discuss the specific surgical plan.
This two-stage approach isn't always necessary, but for complex cases, it ensures I have all the information needed to advise you properly.
Frequently Asked Questions
Generally, you should wait at least 12 months after your primary rhinoplasty for full healing and swelling resolution. However, if the revision will be in a different area than the original surgery, this waiting period may be shorter. I'll assess your specific situation during consultation.
Your previous operation notes tell me exactly what was done during your first surgery. This is invaluable information because I can understand what structures were modified, what cartilage might have been removed, and what I'm likely to find when I operate. Without this information, I'm working with more uncertainty.
Often yes. Scar tissue from the previous surgery can make the anatomy harder to work with. Cartilage may have been removed or weakened. The blood supply may be altered. These factors can make revision rhinoplasty more technically demanding and the results less predictable.
If cartilage grafts are needed, they typically come from your septum (the cartilage dividing your nasal passages) or from your ear. The ear is a common source because it provides good quality cartilage without affecting your appearance. In rare cases, rib cartilage may be needed for extensive reconstructions.