Revision rhinoplasty is surgery to correct or improve the result of a previous nose operation, whether because of a cosmetic concern, breathing difficulty or both. It is usually advised to wait at least twelve months after the first operation so swelling can settle and scar tissue soften. Revision is more complex than primary surgery and often requires cartilage grafts, so realistic goals are essential.
Why revision is sometimes needed
- Residual hump or irregularity: a small bump or unevenness along the bridge that becomes visible as swelling settles.
- Asymmetry: a nose that remains or becomes crooked, or nostrils that look uneven.
- Tip problems: a tip that is too full, pinched, over-rotated or has lost support.
- Pollybeak deformity: fullness above the tip, which can follow over-reduction of the bridge or scar tissue.
- Over-reduction: a scooped or collapsed bridge or a nose that looks too small for the face.
- Breathing difficulty: narrowing of the nasal valves or persistent septal deviation.
Revision can also be requested when a patient’s goals have changed over time, although this is considered carefully.
How long to wait
The nose continues to change for a year or more after rhinoplasty, particularly at the tip. Scar tissue is firm in the early months and softens gradually. Operating too soon makes it difficult to judge the final shape and can make the tissues harder to work with. For these reasons, most surgeons recommend waiting at least twelve months, and sometimes longer for thick skin. The exception is an early problem affecting health, such as a significant septal haematoma or infection, which needs prompt treatment.
Why revision is more complex
After a previous operation, the normal layers of the nose are altered by scar tissue, and the cartilage that would usually be used for reshaping may already have been removed or weakened. The skin can be thinner or less elastic. This means the surgeon often needs to rebuild support rather than simply remove tissue. An open approach is commonly used to allow the structures to be seen clearly. The operation usually takes longer than a first rhinoplasty, and recovery, particularly swelling, can be more prolonged.
Cartilage grafts
Grafts are used to rebuild or reinforce the framework of the nose. The septum is the preferred source when enough cartilage remains. If it has already been used, cartilage can be taken from the ear, through a hidden incision behind or inside it, or from a rib, which provides a larger amount for significant reconstruction. Each source has its own advantages and risks, which Mr Nassab will explain. Ear cartilage is soft and curved, which suits some tip grafts, while rib cartilage is stronger and more plentiful but involves a small incision on the chest and a longer operation. Occasionally, donor cartilage from a tissue bank is considered.
What can and cannot be improved
Revision can often smooth irregularities, straighten a crooked nose, restore support to a collapsed bridge or tip, correct a pollybeak and improve breathing. It is harder to reverse significant thinning or scarring of the skin, and results in heavily operated noses are less predictable. The aim is meaningful improvement, not perfection. Some patients are advised that a further operation is unlikely to help, and this honest guidance is an important part of the consultation.
The revision consultation
Mr Nassab will ask about your original operation, what was done, and what concerns you now. Bringing any operation notes, previous photographs and details of your first surgeon is helpful. He will examine the nose inside and out, assess the skin and scar tissue, and check breathing. If a concern is minor, a non-surgical approach or a small procedure may be appropriate. For some patients, the first step is to return to their original surgeon, who knows what was done.
Recovery and cost
Recovery follows a similar pattern to a first rhinoplasty, with a splint for about a week and bruising over two weeks, but swelling often takes longer to resolve. If rib cartilage is used, the chest donor site will also be tender for a few weeks. Revision rhinoplasty is quoted at consultation because the complexity varies widely. The £150 consultation fee is separate. For the primary procedure, see rhinoplasty.
Frequently Asked Questions
How soon after rhinoplasty can revision take place?
Usually no sooner than twelve months, to allow swelling to settle and scar tissue to soften.
Is revision rhinoplasty more expensive?
It is quoted individually and is often more involved than a first operation, particularly if grafts are needed.
Can breathing be fixed in revision surgery?
Yes. Valve and septal problems are commonly addressed during revision.
Should the original surgeon be consulted first?
It is often worth discussing concerns with your original surgeon, although a second opinion is equally reasonable.
