Secondary Rhinoplasty


What is Secondary Rhinoplasty?

The term rhinoplasty refers to plastic surgery of the nose, often known by most people as a “nose job.” A secondary rhinoplasty is corrective nasal surgery that serves to alter the form and/or function of the nose after a previous rhinoplasty. Secondary aesthetic and reconstructive nasal re-shaping is indicated for cosmetic or functional deformities not properly treated or made worse from the primary operation. Some also refer to secondary rhinoplasty as “revision rinoplasty.” This broader terminology can apply to rhinoplasty required beyond a secondary operation, such as a third or fourth operation.

Patients request secondary rhinoplasty to address specific imbalances that persist, are newly created, or that have become more severe. Often the nose is imbalanced or in disharmony with the rest of the facial features due to an un-anticipated healing complication, improper, or incomplete surgical maneuvers. A secondary rhinoplasty is often much more complicated than a primary rhinopasty. The first time in rhinoplasty is always the best time to address all the cosmetic and functional nasal issues, however with appropriate application of advanced techniques by a rhinoplasty specialist, secondary procedures can be successful. The majority of surgeons who specialize in rhinoplasty also have necessary experience with more complex revisional surgeries and will be able to address patient concerns. Of course, as with primary rhinoplasty, your expectations and goals need to be appropriate and thoroughly discussed with your surgeon. It may be helpful to bring in photos of your nasal appearance prior to your previous operation. Your rhinoplasty surgeon may also request previous operative records and medical records, although this is not mandatory.

Common Problems that Require Secondary Rhinoplasty

  • Nasal airway obstruction
  • Collapse of cartilage or nasal bones
  • Artificial cosmetic appearance to nose (“Overdone nose job”)
  • Internal and external nasal valve collapse
  • Worsened asymmetry
  • Over reduction or inadequate reduction of dorsal height (bridge height/hump)
  • Incomplete shaping (not enough of a cosmetic change)
  • Excessive or inadequate tip projection
  • Excessively narrowed nasal tip (“pinched tip”)
  • Excessive internal and/or external scarring (thickened scar tissue)

The changes necessary in secondary rhinoplasty can be done through a “closed” or “open” approach. Typically, if there are major structural changes required, and open approach may be preferred. Minor contour corrections can be performed via a “closed” technique. Closed rhinoplasty is when only internal incisions (endonasal) are made for access to the nasal structures. Open rhinoplasty refers to the addition of an incision in the skin bridge between the two nostrils (columella) in order to lift up the nasal skin for more direct visualization of the structures to be altered. The decision to use either the closed or open approach in revision rhinoplasty is based on surgeon preference and each technique has its pros and cons.

Cartilage grafts (portions of cartilage from the septum, ear, or a rib) are often necessary to accomplish the cosmetic and functional goals in secondary rhinoplasty. It is very common for the primary procedure to have depleted much of the nasal cartilage. A lack of septal cartilage is the most common indication for needing ear or rib cartilage sources for graft material. These segments of cartilage are then shaped into structural and shaping pieces for use in the nose. As with primary rhinoplasty, there is very little room for error and it is vital that you seek a rhinoplasty expert who is skilled and has vast experience in secondary techniques. In order to reduce the rates of further revisions and ensure a successful outcome, it is best to seek a plastic surgeon or facial plastic surgeon who specializes in rhinoplasty and revision rhiinoplasty. For more information on how to select a rhinoplasty specialist, click here. Your rhinoplasty specialist will listen to your requests and evaluate your nose, both externally and internally. A detail oriented treatment plan that is appropriate will be outlined and can help reduce the rate of needing further corrections.

Am I a good candidate for the surgery?

Secondary Rhinoplasty: Widening of the Dorsal Line The best candidates for secondary rhinoplasty are individuals that are both emotionally and physically healthy as well as realistic about the potential for improvement. One with a secondary nasal problem should be looking for improvement, not perfection. Doctor prefers to carefully evaluate the patient with a secondary nasal problem to assess their deformity and make sure the patient is realistic about the potential revision. Depending on the type of deformity, one may/may not totally improvement of the nasal shape or function. Deciding to have secondary nasal surgery should not be an impulsive decision but rather one that is carefully thought out. That is why it is important to be realistic, be informed and be true to yourself about what really bothers you about your results.

What should I expect from my consultation?

During your secondary nasal surgery consultation, your doctor will ask how you would like your nose improved. He will examine the inside and outside structure of your nose, and discuss the possibilities with you. He will also explain the factors that can influence the procedure and the results. These factors include the remaining structure of your nasal bones and cartilage, the shape of your face, the thickness of your skin, your age, and your expectations.

You will learn about the secondary nasal surgery, its limitations and risks, and discuss your needs and concerns. This will help your doctor better understand your expectations and determine whether they can realistically be achieved. After your consultation a photographer will take photographs for your medical record and you will meet with doctor’s patient coordinator to discuss surgery fees and schedule dates. You may also schedule an additional consultation to preview computer imaging. These may help you visualize the results of each technique that your doctor has specifically designed for your surgery.

Be sure to tell your doctor about all your previous nose surgery or if you suffered an injury to your nose, no matter how long ago it was. You should also advise him of any allergies or breathing difficulties, of any medications or vitamins you take, of recreational drug use, or if you smoke.
How is the surgery performed?

The rhinoplasty surgery for secondary nasal deformity is called an “open approach”. The open approach, which your doctor prefers, is performed by separating the skin of the nose from its supporting framework of bone and cartilage. This approach allows your doctor to see the entire structure of the nose. He will then resculpt the nose to the desired shape. The nature of the sculpting will depend on the nature of your problem and your doctor’s preferred technique. There are an infinite number of techniques which can be utilized to sculpt the underlying framework when dealing with a secondary nasal revision. Some doctors prefer to use the patient’s own tissue (such as cartilage septum, ear or rib).

When the surgery is complete, a splint is applied to help your nose maintain its new shape. Soft plastic splints may also be placed in your nostrils to stabilize the septum and divide the wall between the air passages in order to improve your nasal airway.