Revision rhinoplasty is a second operation on a nose that has already had surgery, to correct problems with appearance or breathing. Ear, nose and throat specialist Op. Dr. Süleyman Kumbasar, whose practice is in Bahçelievler, Istanbul, assesses together the details of the previous surgery, the endoscopic findings, the skin type and the amount of cartilage remaining. A revision is usually planned at least 12 months after the first operation; if needed, support is provided with ear or rib cartilage and a breathing problem is treated in the same operation.
What is revision rhinoplasty?
Revision rhinoplasty is a second or later operation on a nose that has already had surgery, to correct problems with appearance or breathing. Its scope ranges from correcting a small irregularity to rebuilding the support structure of the nose.
Because of the previous surgery, the internal structure of the nose, the amount of cartilage and the tissues under the skin have changed. That is why a revision needs a more detailed assessment and plan than a first rhinoplasty.
When is it considered?
A revision is considered for problems that have become permanent after the first operation and are not expected to improve with recovery:
- A drooping tip or marked asymmetry of the tip
- A pinched look caused by over-narrowing of the tip and weakening of the side walls
- Nostrils collapsing inwards when breathing in
- A dip, bump or irregularity on the bridge of the nose
- A wide upper third because the nasal bones were not brought close enough together
- Breathing difficulty that persists or begins after the first operation
The cause of the breathing difficulty is usually an uncorrected deviated septum, narrowing of the nasal valve or enlarged turbinates; these can be treated in the same operation as the revision.
Why wait at least 12 months?
After rhinoplasty, swelling goes down over months and the tissues mature; the tip, especially in thick skin, keeps changing for up to a year. An assessment while swelling is still present can be misleading, and operating on immature scar tissue is more difficult. That is why a revision is usually planned at least 12 months after the first operation. We explain this in detail in the articles why wait 12 months for a revision and the nasal tip in thick skin.
If a problem makes breathing very difficult, or there is a marked deviation after an injury to the operated nose, earlier surgery may be considered. You do not need to wait 12 months for a consultation: an early assessment helps plan the waiting period.
What is assessed at the consultation?
At a revision consultation, Op. Dr. Süleyman Kumbasar assesses the following information and findings together:
- The date of the previous operation and, if available, the surgical report and earlier photos
- Endoscopic examination of the inside of the nose: remaining septal cartilage, perforations, adhesions and the state of the turbinates
- Skin thickness and scar tissue under the skin
- Support of the tip and side walls, and whether the nostrils collapse when breathing in
- What the patient is unhappy with, and what can realistically be changed
The general steps of the examination are described in the article what is assessed at a rhinoplasty consultation.
Where does the support cartilage come from?
A revision often needs a cartilage graft to rebuild the support of the nose. The first choice is septal cartilage, but if it was used in the previous operation there may not be enough left. In that case cartilage from the ear (behind the outer ear) or rib cartilage is used. The choice is made at the consultation according to the amount and strength needed, and is discussed with the patient before the operation.
How is it different from the first operation?
In a revision, scar tissue makes the tissues harder to separate and the anatomy has been changed by the previous surgery; the open technique is therefore usually preferred. Depending on its scope, the operation can take from under an hour to 3–4 hours. Swelling takes longer to go down, and the final shape usually appears later than after a first operation. The achievable result is limited by the condition of the skin and remaining tissues, so expectations are discussed openly during planning.
What are the risks?
In addition to the general risks of bleeding, infection and anaesthesia, a revision can involve prolonged swelling, changes in the shape of the graft over time, pain and a scar at the donor site (ear or chest) and the need for a further correction. These risks are explained one by one at the consultation before surgery, and written informed consent is obtained.
The surgical process
General anaesthesia. An anaesthetic assessment and blood tests are carried out before the operation.
Depending on the scope, from under an hour to 3–4 hours; using rib cartilage makes it longer.
Septal, ear or rib cartilage; the choice is made at the consultation according to the amount needed.
Usually one night in hospital; for extensive revisions, the length of stay is given at the planning stage.
The external splint is usually removed between days 7 and 10.
Recovery timeline
Bruising and swelling are noticeable. If rib cartilage was used, there may be pain in the chest. Keeping the head raised is recommended.
The splint and stitches are removed; returning to office work is usually possible during this period.
Recovery is enough for social life. Wearing glasses and light exercise are planned according to the doctor’s instructions.
A large part of the swelling goes down; the tip and areas with more scar tissue improve more slowly.
Final shape. After a revision, swelling can take longer to go down completely than after a first operation.
Frequently asked questions
How long after the first operation should I come for a revision consultation?
You do not need to wait for a consultation: an assessment can be made as soon as you notice the problem. The operation itself, however, is usually planned at least 12 months after the first surgery so that the tissues can mature. For problems that seriously affect breathing, earlier surgery may be considered.
If another doctor did the first operation, can I have a revision?
Yes. In that case, for planning, the report and date of the previous operation and earlier photos are requested if available. If there is no information, the assessment is based on the examination and endoscopic findings.
Is rib cartilage always needed for a revision?
Not always. If enough septal cartilage remains, that is used; ear cartilage can be enough for small supports. When the support of the nose needs to be largely rebuilt, rib cartilage is preferred.
Can a revision also correct a breathing problem?
When indicated, yes. Causes of blockage such as a deviated septum, a narrowed nasal valve or enlarged turbinates can be treated in the same operation as the revision. The causes are identified by endoscopic examination.
Is recovery after a revision longer?
Generally, yes. Because of scar tissue and changes in blood supply, swelling goes down more slowly than after a first operation; the final shape appears between months 12 and 18.
Can small irregularities be corrected with filler?
Filler may be considered for some small irregularities; however, in an operated nose the blood supply and skin have changed, so it is not suitable in every case and is decided with care. Suitability is determined at the consultation.
Related treatments
Articles on this topic
Sources
- Ishii LE et al. Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty. Otolaryngology–Head and Neck Surgery, 2017.
- Stewart MG et al. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngology–Head and Neck Surgery, 2004.
The information on this page is for general guidance only; diagnosis and treatment decisions are made by the doctor after a consultation. Results of surgical and interventional procedures vary from person to person.