Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
Send us all your questions or requests, and our expert team will assist you.
Revision rhinoplasty is a major reconstructive procedure performed under general anesthesia. Due to fibrosis and the need for graft harvesting, the surgery typically lasts 3 to 6 hours. A board-certified anesthesiologist monitors the patient, ensuring stable blood pressure to minimize bleeding.
The throat is packed to prevent blood drainage. Local anesthesia with epinephrine is injected extensively into the nose and the donor sites (rib/ear). This step is crucial for “hydro-dissection,” which helps separate the scarred skin from the cartilage and reduces blood loss.
The vast majority of revision cases utilize the open approach. An inverted-V incision is made across the columella (the skin between the nostrils). This allows the surgeon to lift the skin envelope and visualize the entire distorted framework directly.
Lifting the skin in a revision is the most perilous step. The skin is often stuck down to the cartilage. The surgeon must dissect meticulously, millimeter by millimeter, to separate the skin without creating a hole (buttonhole) or damaging the blood supply. This “degloving” reveals the actual state of the nasal anatomy.
If the septal cartilage is depleted, the surgeon moves to the donor site. For ear cartilage, an incision is made behind the ear to harvest the conchal bowl, leaving the shape of the ear unchanged. For rib cartilage, a small incision is made on the chest wall.
A segment of the rib is removed (usually the 6th or 7th rib). The surgeon carefully carves this rib into straight, thin slices. This carving technique is critical for releasing the internal stress forces in the cartilage so it does not warp (bend) over time.
The surgeon rebuilds the nasal foundation. If the septum is weak or missing, an L-strut replacement is created using the rib graft. This restores the strength of the nasal bridge and tip support.
Spreader grafts are placed between the septum and the nasal bones to widen the middle vault and fix the “inverted V” deformity. These grafts also open the internal nasal valve, improving breathing. The framework is sutured rigidly to withstand the forces of scar contraction.
For patients with a saddle nose or scooped-out bridge, dorsal augmentation is performed. A popular technique is “Diced Cartilage in Fascia” (DCF). The surgeon takes leftover cartilage, dices it into a fine paste, and wraps it in a sleeve of temporal fascia (harvested from the temple).
This “burrito” of cartilage is placed on the bridge. It is moldable, allowing the surgeon to smooth it out perfectly. Because it uses the patient’s own tissue, there is no risk of rejection, and the diced nature prevents warping while maintaining volume.
The nasal tip is reconstructed using the harvested cartilage. A columellar strut graft or septal extension graft is used to set the projection and rotation of the tip. This acts as an anchor.
The tip cartilages (lower laterals) are often damaged or asymmetrical. The surgeon may replace them with rim grafts or lateral crural strut grafts to flatten them and prevent collapse. Sutures are used to define the dome points. The goal is a stable, triangular tip that does not droop.
If the nasal bones are crooked or wide, osteotomies are performed. Using an ultrasonic Piezo device or fine chisels, the bones are cut and reset into a straight, narrow position. In revision, the bones may be brittle or previously fractured, requiring extra care.
The Piezo device is particularly valuable here as it cuts bone without damaging the surrounding soft tissue or mucosal lining, reducing trauma and post-operative bruising.
Before closing, the surgeon places layers of camouflage. Revision noses have thin, scarred skin that reveals every imperfection. To prevent grafts from showing, a layer of fascia or crushed cartilage is placed over the tip and bridge.
This “blanket” softens the edges of the rigid grafts and thickens the skin. It ensures the nose feels natural to the touch and looks smooth under light, preventing the “shrink-wrapped” look of a skeletonized nose.
The skin is redraped carefully. The columellar incision is closed with fine, non-absorbable sutures. Internal incisions are closed with dissolvable stitches. Soft silicone splints (Doyle splints) are placed inside the nose to support the septum and prevent scar bands.
A thermoplastic cast is molded over the nose to protect the new shape. If a rib graft was used, a drain may be placed in the chest for a day or two. The patient is gently woken to avoid coughing or straining.
The patient is monitored in the recovery room. Head elevation is mandatory to reduce swelling. Nurses check for hematoma formation (blood collecting under the skin), which is a risk in revision due to the raw surface area.
Pain is managed with IV and oral medication. Patients with rib grafts may experience chest soreness and are encouraged to take deep breaths to help prevent pneumonia. Nausea is aggressively treated.
Send us all your questions or requests, and our expert team will assist you.
The nasal recovery is similar congestion and a cast for a week. However, if we take rib cartilage, you will have chest soreness for several days, making it uncomfortable to laugh, cough, or sit up. It feels like a strained muscle from a heavy workout.
Yes, swelling is typically more prolonged in revision surgery because prior operations have disrupted the skin’s lymphatic drainage. The nose may look swollen for several weeks, and the tip can hold fluid for over a year.
The rib incision is closed with dissolving stitches and covered with a waterproof dressing. You can usually shower after 48 hours. The scar heals as a small line (2-3 cm) and fades over time.
We rarely use packing (gauze). We use silicone splints with tubes, which allow you to breathe a little bit immediately after surgery. These are much more comfortable and are removed painlessly in one week.
If you are flying in for surgery, you typically need to stay for 7 to 10 days. We need to remove the cast and sutures and ensure the nose is healing properly before you get on a plane, as air pressure changes can affect the nose.
Leave your phone number and our medical team will call you back to discuss your healthcare needs and answer all your questions.
Your Comparison List (you must select at least 2 packages)
