Revision Rhinoplasty (Secondary Rhinoplasty)

Rhinoplasty (nose surgery) is one of the most difficult and complex operations in aesthetic surgery. Unfortunately, not every surgery yields the desired result. Corrective surgeries performed for patients who have undergone one or more previous nose surgeries but are unsatisfied with the aesthetic appearance or continue to have breathing problems (or find them worsened) are called Revision Rhinoplasty.

In Istanbul, Op. Dr. Bekir Can Gümüşlü views this challenging process as the “reconstruction of the nose,” aiming to restore both healthy breathing and lost self-confidence to his patients. Revision surgery requires significantly more experience, patience, and anatomical knowledge than the primary surgery. This is because internal tissues may be scarred (adhesions), anatomical planes are disrupted, and most importantly, the cartilage reserves that support the nose may have been depleted. Therefore, it is of vital importance for patients considering revision to be meticulous in their choice of surgeon.

Why is Revision Surgery Necessary? Which Problems Does It Solve?

The most common reasons patients apply to our clinic include:

• Pollybeak Deformity: A humped appearance caused by not removing enough cartilage or bone tissue above the nasal tip.

• Nasal Tip Drooping (Ptosis): The sagging of the nose over time due to insufficient cartilage support.

• Inverted V Deformity: Difficulty breathing and unappealing shadows caused by the collapse of the middle nasal vault.

• Nasal Bridge Irregularities: Bone or cartilage protrusions that are felt by hand or visible from the outside.

• Over-Rotated (Piggy) Nose: Raising the nose more than necessary, making the nostrils directly visible from the front.

• Breathing Problems: Blockages caused by the narrowing of the internal valve angle, even if the nose looks aesthetically pleasing.

Op. Dr. Bekir Can Gümüşlü focuses on the internal architecture of the nose, not just the external appearance, while analyzing these issues.

Use of Rib Cartilage (Costal Cartilage) and Reconstruction

The most critical point of revision surgeries is the lack of “material.” Since a large portion of the septal cartilage inside the nose is typically used or removed during the first surgery, it may be necessary to harvest cartilage from another part of the body to reshape the nose.

• Ear Cartilage: Since it is softer, it is generally used for shaping the nasal tip or for camouflage procedures.

• Rib Cartilage: If strong support is needed to rebuild the bridge of the nose or to lift a collapsed nose, cartilage is harvested from the patient’s own rib (usually the right 6th or 7th rib) through a small 2-3 cm incision.

Op. Dr. Bekir Can Gümüşlü utilizes rib cartilage by thinning it with special techniques (such as the Oblique Split Method), preventing warping, and dicing it when necessary. This results in a nose that has a rock-solid skeleton while appearing extremely natural and elegant from the outside. Although patients may be intimidated by the word “rib,” this procedure is not particularly painful and leaves an almost imperceptible scar in the chest area.

Recovery Process and Timing

The most important rule for revision surgery is timing. At least 6 months, ideally 1 year, must pass after the first surgery for tissues to heal completely, edema to subside, and the nose to take its final shape. Early intervention can increase tissue damage.

The recovery process is similar to the first surgery, but it may take slightly longer for the swelling to go down. Revision surgeries are usually performed using the open technique and can last between 3 to 5 hours. The success of this “second chance” directly depends on the patient’s patience and their strict adherence to the doctor’s instructions (massage, taping, etc.).