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Revision Rhinoplasty

2022-03-01 10:38:26

Dr. Fariba Azadikhah
Reviewed by:
Dr. Fariba Azadikhah

Have you undergone rhinoplasty surgery before? Are you happy about the results? If NO, you may need to have a revision rhinoplasty.

Nose job

The human nose plays an important role in facial esthetic. It's usually considered the most prominent feature of the human face, so transformative procedures need plenty of attention. If you're unhappy with its shape and form, you may consider a nose job as a solution. A nose job is also known as rhinoplasty.



Rhinoplasty is a surgical procedure in which the surgeon tries not only to reconstruct the shape of the nose but also to preserve its airway function. Rhinoplasty is known as one of the most challenging, unpredictable, and complicated facial cosmetic surgeries worldwide.





Types of rhinoplasty: open and close

Open rhinoplasty is performed from outside of the nose when closed rhinoplasty involves incisions in the interior of the nose.


Can you do rhinoplasty twice?

At first, when you undergo a primary rhinoplasty it may not meet your preoperative expectations. Thus, a revision (or secondary) rhinoplasty may help you achieve your goals. There are some reasons for undergoing a revision rhinoplasty:

  1. Failure of the primary rhinoplasty to correct the complaint
  2. Desire to correct a new deformity that shaped after the primary procedure
  3. Loss of personal characteristics


Revision rhinoplasty vs primary rhinoplasty

Secondary rhinoplasty may have more technical and emotional challenges than the primary procedure. There will be some difficulties in revision rhinoplasty due to:

   •    Scarring from the previous procedure
   •    Loss of landmarks
   •    Inadequate knowledge of what was performed before
   •    Unfavorable outcomes from primary rhinoplasty which cause emotional distress

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When should you have a revision rhinoplasty?

People who complain about the following problems, usually seek revision rhinoplasty.

   •    Nasal airway obstruction
   •    Saddle nose deformity
   •    Open roof
   •    Crooked nose
   •    Dorsum asymmetry
   •    Tip asymmetry
   •    Excessive dorsal resection
   •    Residual dorsal hump
   •    Bulbous tip
   •    Drooping tip
   •    Alar collapse
   •    Issues with breathing functionally

There are two types of complaints that lead to choosing a revision rhinoplasty among patients: esthetic or functional.



Revision rhinoplasty specialist

As we said, secondary rhinoplasty (nose job) is more complex and challenging than a primary nose job. So the revision rhinoplasty specialist needs to be confident, professional, and skillful. The specialist must have revision rhinoplasty experiences, therefore you can trust him to perform the surgery correctly.
Our board-certified surgeons are trustworthy revision rhinoplasty specialists. Each has extensive experience correcting or revising surgeries during which previous procedures haven’t met expectations or have corrupted nasal function.
These specialists expertly manage difficult cosmetic and reconstructive surgical cases, and in Ermateb we can help achieve your goals and address your concerns. We take the time to truly understand your goals and help you achieve them.


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What is the success rate of revision rhinoplasty?

Although there are no limits in undergoing rhinoplasty surgeries, the success rate of revision rhinoplasty is around 5% to 10%. The international average for secondary nose jobs is approximately 15% which means that revision nose job is more common than you think.


When should you have a revision rhinoplasty?

If you're dissatisfied with your previous nose job, you may consider undergoing a revision rhinoplasty. The thing is after the primary rhinoplasty you should wait at least a year for undergoing revision rhinoplasty. But why should you wait that long?
While some of the swellings go down immediately, the others can take a year to subside. Besides, it takes at least a year for softening the scar tissue, which can prevent the surgeon from making corrections. If you rush it, it will be great regret for your entire life because you may turn a minor problem into a major one. So be patient about it.



Before the procedure

Like every other surgery, revision rhinoplasty needs preparation before performing. As a patient, you should make sure that you have followed these steps to prepare for your secondary rhinoplasty.

1.  Make sure that your nose is fully healed
As we explained earlier, the healing process takes at least a year. It means if you undergo another rhinoplasty before 12 months, it might not address all post-surgical problems because your nose may not be able to endure another procedure.

2.  Choose your new rhinoplasty specialist carefully
In a patient's eyes, primary rhinoplasty and revision rhinoplasty can seem alike but for the surgeons performing a secondary rhinoplasty is more difficult than the first one. So you need to find an experienced rhinoplasty surgeon who has the required knowledge to perform such a complex procedure.

3.  Book a consultation with the rhinoplasty surgeon
During the physical exam, your surgeon will be able to tell if there was a big loss of structural support during your primary rhinoplasty. If there was, it may be necessary to perform cartilage grafts along with your revision. These grafts may come from the septum, which is what rhinoplasty specialists consider the most effective source of graft material and is local, meaning that there is no need for a second surgical site.
It may be necessary to reap cartilage from the ear or a rib if the septal cartilage has been removed or damaged within the previous nose job. Each of these graft types has advantages and disadvantages which will be discussed during your consultation.


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4.  Get information about your primary nose job from your previous surgeon
Your new rhinoplasty surgeon can tell a bit just by looking at your nose. But to provide you with the best information during your consultation, it’s better if you can provide your preoperative photographs and an operative summary from your previous doctor.

5.  Plan for the costs and recovery time
Revision rhinoplasty generally takes approximately 2-5 hours and you will be under a general anesthetic. It requires the restriction of your physical activity for 6 weeks after the procedure. A splint will remain in place for 8 days after the procedure, and there will be some degree of nasal congestion and swelling for a similar period. You can discuss more details during the consultation.
Because the complication and challenges are more than your first rhinoplasty, the expense is higher. Generally, secondary rhinoplasty costs 50-100% more than a primary rhinoplasty. In Ermateb we will perform a secondary rhinoplasty at different costs which start at 3000 dollars.


In operation room

During revision nose surgery, the goal is to revive both structure and function. In some cases, a specialist will try to recreate symmetry by adding back or taking away cartilage. Extra cartilage can be taken from the nasal septum, your ear, or one of your ribs if your surgeon wants. Newer pre-shaped implant materials like Medpor are virtually resistant to resorption or warping and maybe precision carved for a custom fit. In general, it is easier to fix problems when not enough cartilage was removed during the primary rhinoplasty because your surgeon can return and remove more cartilage. More often, in performing a revision rhinoplasty the surgeon adds cartilage to open the airway or to recreate shape and proportion.

The incisions for revision rhinoplasty involve the interior of the nose (closed rhinoplasty) or on the underside of the nose between the nostrils (open rhinoplasty). Closed rhinoplasty has the benefits of being less traumatic and invasive to the tissues because the surgeon only uncovers the areas that require correction, whereas the open approach has more disconnection and reconnection of structures. The closed approach can consider safer if you have got scarring from earlier nose surgeries, but some surgeons prefer the open approach for the exposure that it provides, or to higher understand and visualize complex cases.



Revision rhinoplasty recovery time

No two patients will heal alike, as each body is unique and can answer the surgery in several ways. Therefore there is no definitive revision rhinoplasty recovery timeline. Here are a few guidelines to help you achieve goals and have an easier recovery :

   •    maintain a healthy diet by eating healthy foods and drinking lots of water.
   •    Do not smoke. If you do, stop it as soon as possible.
   •    Avoid taking specific drugs such as Advil, Aspirin, and Motrin for two weeks before surgery.
   •    Discuss any vitamins, minerals, supplements, and medications which you use, with your surgeon before surgery.

But on average, patients with thin healthy skin may need about 6-12 months, whereas patients with thick skin may require at least 2 years for all manifestations of inflammation to resolve.


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What are the results of the Revision Rhinoplasty?

Although nearly all revision rhinoplasty patients can be improved when appropriate surgical principles are properly applied, absolute completeness is almost impossible. Because of pre-existing tissue damage and the limitations outlined above, cosmetic gains are often stubborn and defective, making step-wise improvement is necessary for the severely injured nose.



In Ermateb we have great doctors with clinical experience and considerable expertise, derived from thousands of nasal surgeries. We will help you get a clear picture of the revision and always consider the patient’s desires. However, like any other surgery, there are specific limits to what can be accomplished. If the surgeon finds it difficult to help the patient achieve the goals, he or she will address this during the consultation. You may know that iran is the capital of rhinoplasty in the world, but WHY?

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