Revision Rhinoplasty: Corrective Guide for Unsatisfactory Nose Surgery Outcomes
Performed to resolve post-surgical airway obstruction or aesthetic deformities, secondary rhinoplasty requires waiting 12 months, frequently relying on costal or auricular cartilage grafts.
Key points
- Mandatory 12-Month Interval: Operating before scar tissue softens and deep sub-SMAS edema completely clears risks irreversible structural compromise.
- Cartilage Depletion & Grafting: In cases where the septal donor reservoir is depleted, structural frameworks are reconstructed using autologous costal (rib) or conchal cartilage.
- Surgical Complexity: Scar contractures, altered landmarks, and compromised vascularity make revision rhinoplasty significantly more demanding than primary procedures.
Frequent Deformities Prompting Revision Surgery
In over 50% of secondary consultations, aesthetic displeasure coexists with severe functional airway impairment. Characteristic secondary deformities include saddle nose caused by overaggressive dorsal reduction, inverted-V deformity from upper lateral cartilage detachment, overly rotated "piggy-nose" tip contracture, internal/external nasal valve collapse on inspiration, and persistent uncorrected septal deviations.
Structural Reconstruction: Costal and Auricular Grafts
The prime surgical objective is restoring biomechanical integrity rather than mere cosmetic camouflaging. When the septal vault is exhausted, autologous 6th or 7th costal cartilage is harvested through a discreet 2–3 cm submammary incision. The rib block is laminated into straight structural plates for septal extension, dorsal augmentation, and alar batten grafts. For minor contour irregularities, pliable conchal cartilage harvested through a posterior auricular approach is preferred.
References
- Toriumi DM. Subtotal reconstruction of the nasal pyramid using costal cartilage. Facial Plast Surg Clin North Am. 2009;17(1):1-19.
- Rohrich RJ, et al. The importance of the internal nasal valve in revision rhinoplasty. Plast Reconstr Surg. 2004;114(5):1253-1260.
- Gunter JP, Rohrich RJ. Augmentation rhinoplasty with autogenous graft. Clin Plast Surg. 1996;23(2):233-243.