When is it necessary to revise a nose?
There are two groups of reasons. Medical issues that require immediate attention: infection, exposed materials, increasing redness, progressively retracting nose, breathing difficulties due to a deviated septum after surgery. Aesthetic issues that can wait: slightly deviated bridge, bulbous tip, overly high or straight shape that doesn't suit the face, visible step on the bridge. The second group should wait at least 6–12 months for swelling to subside and scars to soften, as many 'errors' in months 2–3 can self-correct.
Why is it more difficult than the first time?
The subcutaneous tissue has become fibrous and adhered, making layer separation unclear, complicating dissection and increasing the risk of skin damage; the skin on the tip of the nose is often thinner after previous procedures; the septal cartilage may have been removed, and ear cartilage has already been utilized; anatomy has been altered by the previous surgery, so the surgeon must 'read' each layer during the operation. The surgery duration is longer, swelling lasts longer, and the prognosis is more cautious—especially in noses that have undergone multiple revisions.
Materials for revision rhinoplasty
Autologous cartilage is prioritized: septal cartilage (if available), ear cartilage (for tip coverage, small pieces), rib cartilage (when a larger volume and rigidity are needed to support the structure and lengthen a retracted nose). For thin skin, the surgeon may also use temporal fascia or autologous soft tissue as a cushion between the framework and the skin. Synthetic materials may still be used on the bridge if the skin is thick enough and there is no history of infection.
Risks to be aware of
Higher than the first time: prolonged swelling (3–6 months), thin skin with inadequate blood supply, scar contracture causing shape changes over time, grafted cartilage warping or becoming visible, prolonged stiffness of the tip, extended numbness of the tip, results not meeting expectations requiring further adjustments, infection, scarring at the rib cartilage harvest site. For severely retracted noses, a two-stage approach may be necessary.
At BonBoz
A specialized plastic surgeon conducts a direct examination, reviews medical records and previous photos if available, assesses the remaining skin, materials, and cartilage, checks breathing function, and performs a CT scan if a deviated septum is suspected. The surgeon prioritizes: addressing medical issues first (removing materials, controlling infection), then reconstructing the framework with autologous cartilage and soft tissue padding when the skin is thin; clearly explaining the possibility of a staged approach and the limitations of the results. The examining surgeon is the one who performs the surgery and follows up until month 12.
