If you have had rhinoplasty and are unhappy with the result, or your breathing has been worse since, you are not unusual. Revision surgery may be required in up to 10% of cosmetic rhinoplasty cases, and it is a significant part of my practice.
This page is about what revision surgery involves, what it can and cannot correct, and how to think about whether to have it.
Three things change once a nose has been operated on.
Scar tissue. The planes a surgeon works through are no longer clean. Tissue that separated easily the first time is now adherent and less predictable, and the skin envelope has usually lost some of its ability to redrape.
Missing structure. Most unsatisfactory results follow removal of too much cartilage or bone. That support has to be rebuilt before the nose can be reshaped, which means grafting.
Less margin for error. In a primary rhinoplasty there is usually some cartilage to spare. In a revision there often is not, and the changes are measured in fractions of a millimetre against tissue that behaves less predictably.
This is why revision takes longer, why it needs more planning, and why the result takes longer to settle. It is often also helpful to obtain the operation notes from your previous surgery. Knowing what was done, and what was taken, changes the plan.
Potentially correctable: a residual or over-resected dorsal hump, asymmetry, a nose that remains deviated, an over-rotated or under-projected tip, irregularities that can be felt or seen along the bridge, and breathing obstruction caused by loss of support.
Improvable rather than fully correctable: thick skin that will not redrape over a refined framework, significant loss of skin quality, and results where a great deal of the underlying structure has been removed. These can be made better. They may not be made to look as though the first operation never happened.
I would rather say that at consultation than after surgery. If I do not believe I can deliver a worthwhile improvement, I will tell you, and I will say why.
Most revisions need cartilage. Where it comes from depends on what is left.
Septal cartilage is the first choice where enough remains. It is close to hand, it handles well, and it does not require a second surgical site.
Ear cartilage is the usual second option. It is curved rather than straight, which suits some purposes better than others, and taking it leaves the shape of the ear unchanged.
Rib cartilage is used where a lot of structural support is needed, typically in noses where much of the framework has been removed or in complex functional reconstruction. It provides strong, plentiful material. It also means a second incision, more discomfort in the first week, and a longer operation.
Which of these applies is a decision made at consultation and confirmed at surgery, since what is available is not always fully known until the nose is opened.
Wait at least twelve months from your last operation, and often longer.
The reason is not caution for its own sake. A nose continues to change for a year and more, particularly at the tip and particularly in thicker skin. Noses that look irregular at three months frequently settle. Operating into swelling means operating on a nose that is not yet the nose you will have, and the risk of making things worse rather than better is real.
The exception is a functional problem that is not going to improve with time, or an obvious structural collapse. Those can be assessed sooner.
A large proportion of the revision patients I see have breathing problems as well as appearance concerns, and often the two have the same cause. Over-resection of the framework narrows the internal valve, and a nose that has been made too small from the outside is frequently too small on the inside as well.
Where that is the case, the reconstruction addresses both at once. The airway is assessed directly at consultation rather than by history alone.
If you can obtain them, they make a material difference:
These are not essential before your first consultation, and I understand that asking a previous surgeon for records can be uncomfortable. But knowing what was done is more useful than any amount of inference from examining the result.
Revision patients travel further than most, and I see people from across Queensland and interstate. The first consultation can be done by video. The second is in person and involves a full examination, and there is a required seven day cooling off period between that appointment and surgery, so the trip needs planning.
You will be reviewed here at day seven after surgery before you travel home, and clearance to fly is given at that review rather than to a fixed timetable.
If anything is concerning you once you are home, contact us directly. Your care stays with the surgeon who operated on you.
Revision rhinoplasty carries the same risks as primary surgery, and in some respects a greater share of them. Scar tissue, compromised blood supply and grafted material all make healing less predictable. A proportion of revision patients need a further procedure.
The full discussion of risks and expected recovery is set out on our risks page and forms part of every consultation.
The consultation is an assessment, not a booking. I do not offer surgery to everyone who consults me, and that is more often true in revision than in primary work. I will only proceed where I am confident that surgery can deliver a worthwhile and lasting improvement. Where I do not think that is the case I will say so directly, and I may suggest waiting, a different approach, or a second opinion.
Cosmetic surgery in Australia requires a referral from your GP, two consultations on separate days, and a seven day cooling off period before surgery.
Before and after photographs of revision patients are in the gallery, with the time since surgery stated for each. Results vary between patients and no surgical outcome can be guaranteed.
(07) 3202 4636