Revision Rhinoplasty

Revision rhinoplasty describes any operation on a nose that has already had surgery. Patients usually come for one of two reasons: the nose does not look the way they hoped, or it no longer works the way it should. Often it is both.

• ·A nasal tip that droops, especially when smiling
• ·A tip that is too short or upturned, showing the inside of the nostrils
• ·An over-reduced bridge that looks scooped, pinched or narrow
• ·An inverted-V deformity, where bone and cartilage look like two separate parts
• ·A crooked or asymmetric nose
• ·A lost angle between forehead and nose, so the profile runs in one unnatural line
• ·Blocked breathing that began after the first operation

Most of these problems share a single cause: the structures that support the lower half of the nose were weakened or removed. Taking more tissue away rarely helps. The nose needs its support given back.

Prof. Tezel treats the septum, the cartilage wall that divides the nose, as the load-bearing column of the lower nose. In revision cases it is frequently short, bent or weakened, and the tip has nothing firm to stand on. The first step is to restore it.

He does this with caudal septal grafts: a patch carved from the patient's own cartilage in a stair-step pattern so that it interlocks with the existing septum like a puzzle piece. Different designs add projection, reinforce thin cartilage, bring a deviated septum back to the midline or lengthen a nose that was made too short. His septal lengthening technique was published in 2015.

The tip cartilages are then fixed onto the rebuilt septum with the septocolumellar suture system, a sequence of sutures that sets the tip's projection, its rotation, the angle between nose and lip, and the definition of the tip itself. The technique was first published in the Annals of Plastic Surgery in 2007 and has since been refined over thousands of operations. It is the same method Prof. Tezel uses in closed rhinoplasty.

Sometimes a very large problem can be solved with a small intervention. In other noses, earlier surgery has removed so much that the framework has to be reconstructed. Septal cartilage is always the first choice. When it has already been used or is insufficient, cartilage from the ear or, in more complex cases, from the rib is used instead.

The principle does not change: use the patient's own tissue, restore the structure, and only then refine the shape.

Whenever the anatomy allows, Prof. Tezel works through incisions inside the nostrils. Leaving the skin attached to its framework means less swelling, no scar across the columella and, particularly valuable in revision work, the ability to judge the result while it is being made, because the skin stays where it will heal.

Some heavily scarred noses still require an open approach. This is decided at consultation, not on the day of surgery.

A nose that looks right but does not breathe well is not a successful result. Straightening the septum, supporting the nasal valves and fixing the alar cartilages in the correct position are part of every revision plan. Many patients notice easier breathing, and some find their snoring improves.

We usually recommend waiting at least twelve months after the previous operation, so that swelling has settled and the tissues have softened. Small, well-defined problems can occasionally be corrected earlier, sometimes under local anaesthesia.

1. 01Day 1: discharge the morning after surgery.
2. 02Days 7–10: splint and internal supports removed; most bruising has faded. You are usually cleared to fly home.
3. 03Weeks 2–3: return to work and social life.
4. 04Weeks 6–8: the cartilages fuse into a stable 'biological cast'. Avoid pressure on the nose, massage and contact sport during this period.
5. 05Months 12–18: previously operated skin settles slowly; this is when the final definition appears.

As with any operation, revision rhinoplasty carries risks, including bleeding, infection, prolonged swelling, asymmetry and the possibility of a further minor correction. Scar tissue from earlier surgery makes revision technically more demanding than a first rhinoplasty. Prof. Tezel will tell you plainly what can and cannot be improved in your nose before you decide.