What is it and how is it done?
Revision rhinoplasty (secondary nose surgery) is corrective surgery for people who have had a previous nose operation and are unhappy with the result. Common problems include irregularities along the bridge, a hump that remains or a collapse caused by removing too much, a tip that has dropped or is turned up too far, a pinched-looking tip, asymmetry, and nasal blockage that began or worsened after surgery. Problems with shape and breathing often occur together and are treated in the same operation.
Revision rhinoplasty is more complex than a first rhinoplasty. The previous operation leaves scar tissue in the nose; part of the cartilage support may have been removed or weakened, and the skin may have become thinner or lost its elasticity. For this reason an open approach is usually preferred, and cartilage grafts are needed to rebuild the lost support. Septal cartilage from the middle of the nose is the first choice for grafts. If the septum has already been used, ear cartilage is taken through a small incision behind the ear, or rib cartilage through a small incision on the chest. Ear cartilage is soft and curved and works well at the tip and for small defects; rib cartilage provides a larger amount and stronger support and is preferred when the bridge has to be rebuilt.
Timing matters. After the first operation, it is usually advisable to wait at least 12 months for the swelling to settle and the scar tissue to soften. Before then it is difficult to judge the true shape of the nose, and the tissues are not ready for another operation. In situations such as severe breathing obstruction or a displaced graft, earlier surgery is considered separately, depending on the examination.
Goals need to be realistic. In revision surgery the aim is to clearly reduce the problems that bother you most, strengthen the supporting framework of the nose and open up the airway; scar tissue and skin quality can limit how refined the result can be. 3D facial imaging and simulation help in discussing achievable goals together, but they cannot show how scar tissue will affect healing.
Planning is easier if you bring the report or operation note from your previous surgery, photos from before and after the first operation, any CT images, and details of filler or other treatments done on your nose since then. At the practice in Nişantaşı, Prof. Dr. İlker Yazıcı examines the inside and outside of the nose, assesses the cartilage support by touch, evaluates the airway and discusses with you which graft source is appropriate.
What are the aims?
- To reduce shape problems left by the previous operation, such as irregularity or collapse along the bridge, asymmetry, or a tip that droops or is turned up too far.
- To rebuild the weakened internal support of the nose with cartilage grafts.
- To open up the airway where there is blockage, by treating the septum, the nasal valve area and the turbinates.
- To create a natural-looking structure that suits the face and holds up better against loss of support over time.
- To camouflage irregularities that show through thin skin, using soft-tissue grafts where needed.
Who is it suitable for?
- Usually at least 12 months have passed since your first nose operation.
- You have a specific problem with the shape, symmetry or profile of your nose that you can describe.
- You have nasal blockage that started or got worse after the previous operation.
- Your general health allows surgery and, if needed, the harvesting of rib cartilage.
- Your expectations are realistic, aiming for a meaningful improvement rather than a complete correction.
- You are able to stop smoking before surgery and throughout recovery.
- You can set aside time for a recovery that may take longer than after the first operation.
When is it postponed or not recommended?
- Too little time has passed since the first operation and the nose is still swollen; unless there is a specific reason, surgery is postponed.
- People with an uncontrolled chronic illness or a health problem that rules out anaesthesia.
- People with intense, persistent worries about their appearance even though the examination finds no clear problem; if body dysmorphic disorder is suspected, a psychiatric assessment is advised first.
- People who cannot stop smoking; smoking further reduces the blood supply of a nose that already contains scar tissue.
- People with an active infection inside the nose, an unhealed wound or another nasal condition that needs treatment first.
Alternatives
- Waiting and monitoring
- Some irregularities seen in the first year after surgery improve as the swelling settles, so waiting is also an option.
- Limited correction
- If the problem is limited, such as a small bump on the bridge, a smaller procedure through a closed approach may be enough.
- Camouflage with filler
- Small dips along the bridge can be hidden temporarily with hyaluronic acid filler, but because the circulation of a nose that has had surgery is altered, the risk of blocking a blood vessel needs to be weighed more carefully.
- Functional surgery only
- If breathing is the main complaint, surgery on the septum, nasal valve and turbinates can be considered without changing the outside of the nose.
The process step by step
- 1
First contact
You can send the date of your previous operation, current photos of your nose (if possible, also photos from before the first operation) and a short description of your concerns by WhatsApp or e-mail, or call the practice. This information gives you a general idea of the options and helps plan the examination; the medical assessment and the decision take place at the examination in Nişantaşı.
- 2
Consultation
Prof. Dr. İlker Yazıcı examines the inside and outside of your nose, assesses the cartilage support by touch and evaluates the airway; achievable goals are discussed together using 3D imaging and simulation.
- 3
Planning and preparation
A CT scan is requested if needed, and the graft source (septum, ear or rib) is decided. Blood tests, an anaesthetic assessment and adjustments to medication and smoking follow, and you receive a written plan and cost information.
- 4
Surgery
The operation is performed under general anaesthesia in an accredited partner hospital, usually through an open approach; it generally takes 3–5 hours and is followed by one night in hospital.
- 5
Splint removal and first check-ups
The splint and stitches are removed at around day 7–10; if rib or ear cartilage was taken, that wound is checked as well.
- 6
Long-term follow-up
Check-ups usually take place at 1, 3, 6 and 12 months; because swelling at the tip can take 12–18 months to settle, the final assessment is made during this period.
Recovery timeline
Days 1–3
A splint sits on the nose, and swelling and bruising are noticeable. If rib cartilage was taken, the chest is sore, more so with deep breaths and movement; this is controlled with painkillers. Call the clinic straight away if bleeding increases, or if you develop a fever or shortness of breath.
Days 7–10
The splint and stitches are removed. The nose looks clearly swollen; its appearance at this stage does not reflect the final shape.
Weeks 2–3
Most of the bruising has gone, and most people return to desk work and social life. Regular nasal rinsing continues.
Weeks 4–6
Exercise is resumed gradually; contact sports and activities with a risk of a knock to the nose wait for your surgeon's approval. For most people, tenderness at the rib site has eased considerably by now.
Months 3–6
The bridge becomes better defined, and firmness and swelling at the tip slowly reduce. This happens more slowly in noses with scar tissue and thick skin.
Months 12–18
The final shape has largely emerged; this is the time to assess the result and consider any minor touch-ups.
Risks and possible complications
Every surgical procedure carries risks. Your personal risk is assessed in detail at the consultation.
- Prolonged swelling: because of scar tissue, swelling at the tip can last longer than after the first operation.
- Graft-related problems: a graft can shift, warp slightly over time (especially rib cartilage), or its edges can be felt under thin skin.
- At the rib donor site: pain, a scar and, rarely, injury to the lining around the lung (pneumothorax), which is checked for during the operation.
- If ear cartilage was taken: temporary swelling or a collection of blood in the ear; the outward appearance of the ear usually does not change.
- Infection and bleeding: when grafts have been used, it is important to contact your surgeon quickly if you notice fever, increasing redness or discharge.
- Poor blood supply to the skin: the risk is higher in thin skin that has been operated on before, especially in smokers.
- Limited improvement in breathing, scar bands (adhesions) inside the nose or a hole in the septum (perforation).
- A gap between expectations and the result and, rarely, the need for a further revision.
- Risks related to general anaesthesia; your individual risk is discussed during the anaesthetic assessment.
What determines the cost?
The cost of revision rhinoplasty varies more than that of a first rhinoplasty, because every nose is left in a different condition by the previous operation. The main factors are the extent of the problems to be corrected, whether cartilage grafts are needed and where they are taken from (septum, ear or rib), additional airway procedures, the length of the operation, tests such as a CT scan, the hospital stay and anaesthesia costs.
It would not be accurate to quote a single figure before an examination. After the examination with Prof. Dr. İlker Yazıcı, you receive a written, itemised quote for the planned procedures that states what is included; it is a good idea to ask any questions about what the quote covers before you decide on surgery.
If you are coming to Istanbul
The practice is authorised by the Turkish Ministry of Health for international health tourism (certificate no. ST-2365); help with accommodation near the clinic and airport transfer can be arranged through authorised partners. If you are travelling from abroad or from another city for revision rhinoplasty, plan to stay in Istanbul for about 10 days after surgery, until the splint and stitches have been removed; if rib cartilage is used, allow a few more days. Back home, you stay in touch with the practice by sending photos and messages; if something needs to be examined, a check-up in Istanbul or a visit to a local doctor is arranged. Return visits to the practice are usually advised at 3 and 12 months.
Frequently asked questions
How long after a nose job can revision rhinoplasty be done?
Revision rhinoplasty is usually planned at least 12 months after the first operation. This time is needed for swelling to settle, for scar tissue to soften and for the true shape of the nose to show; when surgery is done too early, the tissues are firmer and bleed more, and the result is harder to predict. In specific situations, such as severe breathing obstruction or a displaced graft, earlier surgery may be considered depending on the examination.
Why is revision rhinoplasty more complex than a first rhinoplasty?
Revision rhinoplasty is performed on a nose that has already been operated on and contains scar tissue. Part of the cartilage support may have been removed or weakened, and the skin may be thinner or less elastic. Rebuilding the missing structure often requires cartilage grafts, so the operation takes longer. Planning is therefore more detailed, and recovery, especially the settling of swelling at the tip, can take longer than after a first rhinoplasty.
Where is cartilage taken from in revision rhinoplasty?
In revision rhinoplasty, septal cartilage from the middle of the nose is the first choice for grafts. If the septum has already been used or there is not enough of it, ear cartilage can be taken through a small incision behind the ear; the outward appearance of the ear usually does not change. When more cartilage and stronger support are needed, rib cartilage is taken through a small incision on the chest. The right source is decided at the examination, based on how much cartilage remains and what is needed.
Is revision rhinoplasty painful, and does taking rib cartilage leave a scar?
Revision rhinoplasty is performed under general anaesthesia; the discomfort in the nose is similar to that after a first rhinoplasty and is controlled with painkillers. If rib cartilage is taken, the chest is noticeably painful in the first days, especially when breathing deeply and moving, and this usually eases over a few weeks. The incision is a few centimetres long and leaves a permanent scar; in women it is usually placed close to the crease beneath the breast.
How long is recovery after revision rhinoplasty?
After revision rhinoplasty the splint and stitches are usually removed on day 7–10. Most bruising fades within two weeks, and most people return to desk work and social life after 2–3 weeks. Sport and heavy lifting wait 4–6 weeks. Because of scar tissue, swelling at the tip settles more slowly than after a first operation. Patients travelling to Istanbul are advised to plan a stay of about 10 days after surgery.
Can revision rhinoplasty also fix breathing problems?
If nasal blockage began or got worse after a previous operation, its cause is investigated at the examination. Common causes are a remaining septal deviation, narrowing of the nasal valve, enlarged turbinates or adhesions. These problems can be treated in the same operation as revision rhinoplasty, with the aim of making breathing easier. If allergy or another non-surgical cause also plays a part, medication may be needed as well.
What should I bring to a revision rhinoplasty consultation?
For a revision rhinoplasty consultation, bring the date of your previous operation and, if possible, the operation note or discharge summary, photos from before and after the first operation, and any CT images of your nose. If you have had filler or another treatment on your nose since then, it is important to mention the date and type. A list of your medications and a note of your concerns in order of importance also make the consultation more productive.
When will I see the final result of revision rhinoplasty, and will it last?
In revision rhinoplasty, scar tissue and skin quality mean the final shape emerges later than after a first operation; swelling at the tip can take 12–18 months to settle, and longer in thick skin. The support rebuilt with cartilage grafts is designed to last for a long time, but the nose continues to change with age. It is advisable not to decide on any further procedure before this period has passed.
What does the cost of revision rhinoplasty depend on?
The cost of revision rhinoplasty depends on the extent of the problem, whether cartilage grafts are needed and where they are taken from (septum, ear or rib), additional airway procedures, the length of the operation, the tests required, and hospital and anaesthesia costs. It would not be accurate to quote a single figure without an examination; after the examination with Prof. Dr. İlker Yazıcı, you receive a written, itemised quote.
Does smoking affect revision rhinoplasty?
Yes. In revision rhinoplasty the skin and tissues of the nose already have a reduced blood supply because of the previous operation; smoking reduces it further, slows wound healing, makes it harder for grafts to take and raises the risk of skin problems. Stop smoking at least 4 weeks before surgery and do not smoke during recovery. Blood thinners and some herbal supplements should also be mentioned at the consultation and adjusted on medical advice.
Last updated: · Responsible for content: Prof. Dr. İlker Yazıcı · info@ilkeryazici.com