Ninety-five percent of our patients never go through a second nose operation. Five percent do, and I would rather tell you that at the consultation than let you find it out afterward. “What if the result isn’t what I wanted?” is a question I want to hear before surgery, while we can still plan around it.
What does revision mean in rhinoplasty?
Revision surgery means a second operation carried out to correct a deformity that has developed after the first one. It isn’t designing a new nose. It is a correction aimed at a specific problem that has appeared since the original surgery.
We perform it for patients who have had one or more previous rhinoplasty operations and want an improvement in how their nose looks, and often in how they breathe. That breathing part matters. Revision isn’t always about appearance. Sometimes it is about correcting a narrowing in the airway.
Does every patient need revision rhinoplasty?
No. 95 percent of our patients never go through this, and we are fortunate in that. But in 5 percent of patients the risk unfortunately exists. We tell you this clearly before surgery, because we want a process with no surprises.
That figure depends largely on how tissue heals. Two operations done with the same technique can heal in two different ways in two different people. Surgical planning is the part we control. How tissue heals isn’t entirely in our hands.
The risk is lower in a nose being operated on for the first time. It rises in a nose that has been operated on before, because there we are working with scar tissue.
Is it swelling, or something that genuinely needs revision?
This is the thing that gets confused most often, and getting the distinction right changes everything.
Seeing the final result after rhinoplasty asks for patience, and the biggest factor is your skin. If your skin is thick, the wait is longer, around 12 to 18 months. If your skin is very thin, we can say the result is there at 6 months. A year is the average point at which a nose reaches its final shape.
Most of the complaints we hear in that period are the normal course of healing. Patients point to fullness across the bridge, a tip that looks thicker than it is, or two sides that seem to have healed unevenly. All of these can be down to swelling and settle with time. At the consultation we also get an idea by pressing gently with a finger. Fullness caused by swelling reduces temporarily under pressure. If there is a structural problem underneath, it meets the finger as a firm edge.
The situations that genuinely fall under revision are different. A collapse that narrows the airway. An obvious asymmetry that isn’t correcting itself. An area that was under-treated or over-treated at the first operation. A deformity caused by weakened cartilage support. These don’t resolve on their own.
Why do we wait at least a year before a revision?
When a situation like this comes up, we ask patients to be patient for at least a year, and then we perform the operation.
There are two reasons. The first is that the swelling has to resolve completely. The nose you see at six months is not your final nose. The second is that the scar tissue has to mature. Operating while the tissue is still firm and still changing shape means you can’t fully see what you are correcting.
Deciding early often turns into an unnecessary operation. That is why we bring you in for regular check-ups through this period and track the change with photographs.
Why is revision rhinoplasty harder than the first operation?
This is also why we spend so much time on planning the first one.
Scar tissue. The tissue planes that were clean in the first operation are closed up with adhesions in the second. Dissection becomes harder and the tissue moves less predictably.
Missing cartilage. In a revision we often have to replace cartilage that was removed or damaged during the first operation. If the septal cartilage was used then, we have less material to work with.
The need for grafts. So we take cartilage from elsewhere, from the ear or, where it is needed, from a rib. Cases requiring rib cartilage are the most complex group.
What do we do at the first operation to lower the chance of a revision?
The time we spend on planning is what pays off here. We work on your photographs before surgery, we go through your wishes and expectations one by one, and we tell you plainly what your anatomy will allow.
In every patient it suits, we use the tissue-sparing approach, preservation rhinoplasty. The technique lets us shape the nose while protecting the bridge and the ligaments as far as possible. That means faster healing, and a result that keeps the character of your own nose.
We ask a few things of you after surgery as well. Light exercise is allowed from the first month, and heavier training from the second. We generally advise against combat sports and boxing, because trauma can cause a deformity to develop again.
Frequently Asked Questions
When can revision rhinoplasty be performed?
At least a year after the first operation. That time is needed both for the swelling to resolve completely and for the scar tissue to mature. Assessing it earlier is misleading.
My nose doesn’t look right at six months, do I definitely need a revision?
Most likely not. In thick skin the final result takes 12 to 18 months on average, and in thin skin we consider it settled at 6 months. That is why we don’t make a decision on what a nose looks like at six months.
Will revision rhinoplasty leave a scar too?
That depends on the technique we use. The open technique leaves a small scar on the columella, the strip of tissue between the nostrils. The closed technique works entirely from inside the nose and leaves nothing on the surface. Which technique suits a revision depends on the current state of your nose.
I had surgery with another surgeon, can I come to you for a revision?
You can. At the consultation we look at the current state of your nose and at how long ago the first operation was. If you have records from that surgery, bring them with you, because they make our job easier.
If you are wondering how the swelling of the first months normally settles, our article on swelling and bruising after rhinoplasty is worth a look. If you are still at the stage of deciding on a first operation, how to choose the right plastic surgeon will help too.
Dr. Alper Eskalen assesses revision rhinoplasty for each patient with all of these details in mind.
