Nose Revision (Revision Rhinoplasty)

The nose, your face’s centerpiece, is a complex structure.

It is made up of bone at the top and several cartilages in the lower two-thirds. Internally, the septum is the “dividing wall” of the nose made up of both bone and cartilage. The septum helps support your nose and control airflow. The anatomic relationship between the septum, nasal bone and cartilages, as well as the overlying skin, holistically forms the shape and structure of your nose.

The nose, however, is not an isolated organ; the overall harmony between the nose and the rest of the face—features such as the eyes, lips, chin, and forehead—is critical in determining your face’s overall appearance.

In primary rhinoplasty, the surgeon works with a “clean slate,” shaping this structure to enhance your facial harmony. Revision rhinoplasty is more like a renovation project. The surgeon must work around changes from the previous surgery, such as scar tissue, altered anatomy, or even missing cartilage. There may be collapse of structures that can lead to nasal breathing issues.

In short, revision rhinoplasty is a much more intricate and complex procedure, requiring a surgeon with a deep understanding of the nose’s architecture and an artistic eye for balance and proportion.

It is important to note that surgeons generally recommend waiting at least one year (and maybe even longer) after your primary rhinoplasty before considering a revision.

This allows enough time for the swelling to fully subside and the nasal tissues to heal, providing a clear picture of the final result. The approach your surgeon takes will depend on your specific needs and the results of your previous surgery. But in the end, the goal is the same: to create a nose that feels like it was always meant to be a part of your face, enhancing your natural beauty and complementing your other facial features.

Revision rhinoplasty can be performed using an “open” or “closed” approach, depending on the specific needs and complexities of the case.

Open rhinoplasty involves making a small incision on the columella, the tissue between the nostrils, which allows the surgeon greater visibility and access to the underlying nasal structures. This approach is particularly beneficial for more complex revisions, as it provides the surgeon with a clear view and the ability to make precise adjustments.

Closed rhinoplasty involves making incisions inside the nostrils, resulting in no visible external scarring. This technique is typically used for less complex revisions, where extensive visibility and access are not as crucial.

“Preservation” rhinoplasty is a technique that focuses on maintaining as much of the original nasal structure as possible while making the necessary corrections. This approach aims to preserve the natural anatomy and avoid excessive removal or alteration of tissues.

In revision rhinoplasty, cartilage grafts are often required to reconstruct and support the nasal framework. These grafts can be obtained from various sources, including the septum, rib, ear, or even a cadaveric rib. Each source has its advantages. Septal cartilage is commonly used for its availability and suitability, for example, while rib cartilage provides robust support for more extensive reconstructions.

In addition to making these determinations, managing the nasal skin is crucial for a successful outcome. Temporalis fascia, a strong and flexible tissue from the temple area, can be used to cover the grafts and ensure a smooth and natural appearance of the nasal skin.

If there are breathing issues, additional procedures may be required alongside revision rhinoplasty. A septoplasty can correct a deviated septum to improve airflow. Turbinate reduction surgery can address enlarged turbinates (thin shelves of bone in the sides of the naval cavity) that obstruct nasal passages. Your surgeon may also need to address the nasal valves, which are critical areas for regulating airflow and ensuring optimal breathing function.

Talk to your surgeon about what approaches best suit your needs and which procedures might be combined to help enhance both the appearance and function of the nose.

Before you go

Effectively communicating your goals to your surgeon is a crucial part of planning a successful revision rhinoplasty.

The primary goal of rhinoplasty, whether it is a primary or revision procedure, is to achieve improvement rather than perfection. The aim is to enhance the overall appearance and function of the nose, creating a more balanced and harmonious facial profile. It is important to have realistic expectations, understanding that while significant improvements can be made, perfect symmetry and flawlessness are not always achievable. The focus is on achieving a natural and aesthetically pleasing result that complements the patient’s unique facial features.

It may be prudent not to undergo revision surgery if you like the overall appearance of your nose but are unhappy with subtle issues. Revision surgery has its own inherent risks, and you only want to proceed with another surgery if there are major issues relating to your initial surgery.  It is crucial that you and your revision rhinoplasty surgeon are both in agreement before proceeding with surgery.  If your expert surgeon advises against surgery, it’s important to follow their recommendation and not pressure them to proceed. You may, of course, seek a few opinions from other rhinoplasty experts, but limit it to three or four consultations.

Prior to surgery, your physician may request that you bring photos of noses you find appealing. This helps to communicate your aesthetic preferences clearly. Your surgeon might also use morphing software to create visual simulations of potential outcomes, providing you with a road map to what may be achieved. This collaborative approach ensures that both you and your surgeon have a clear understanding of your goals, leading to more satisfactory and personalized results.

Your surgeon will also provide specific pre-surgery instructions, such as avoiding certain substances or medications. It is vital to adhere to these instructions carefully to ensure the best possible outcome.

During the procedure

Revision rhinoplasty is typically performed under general anesthesia, ensuring you remain pain-free during the procedure.

Incisions are usually made both externally on the columella, the tissue between the nostrils, and internally inside the nose. Additional incisions may be necessary in other areas of the body if cartilage is harvested from the rib or ear, or if temporalis fascia is obtained from the temple. Despite the multiple sites involved, these incisions generally heal very well, with minimal visible scarring over time, when there is careful surgical technique and proper post-operative care.

Nose Revision Aftercare 

Immediately after surgery, you’ll likely have a nasal splint internally and cast on the bridge; these are usually removed within a week. Many surgeons no longer “pack” the nose with gauze, although it may still be necessary.

You may experience swelling, bruising, and discomfort, which can be managed with acetaminophen (Tylenol) or prescribed pain medication. It’s important to rest, avoid strenuous activities, and keep your head elevated to minimize swelling.

Bruising typically lasts for a few days and swelling can take a few weeks to subside, but most patients are comfortable returning to work in about two weeks. Every patient’s experience is unique, and your surgeon will provide the most accurate timeline and recovery plan based on your specific procedure. Final results from revision rhinoplasty may take up to two to three years to manifest, so patience is paramount.