Secondary or revisional rhinoplasty is a much more involved surgical procedure that is done to restore both nasal shape and function. This is usually the result of previous surgery or trauma. It can also help relieve breathing problems.

A patient who is considering a secondary or revisional rhinoplasty should carefully select his or her surgeon. SECONDARY RHINOPLASTY IS THE MOST DIFFICULT COSMETIC PLASTIC SURGERY PROCEDURE TO PERFORM SUCCESSFULLY IN A CONSISTENT MANNER. The difference between a good result and a poor result in a secondary rhinoplasty is 1-2 millimeters. It is essential that you choose an experienced secondary rhinoplasty surgeon who is not only qualified, but a surgeon who has a strong aesthetic style and talent in secondary rhinoplasty. Secondary rhinoplasty surgery is so much more as it is about art and is surgery to realistically achieve the patient’s goals.

Dr. Rohrich is a *board-certified, internationally recognized plastic surgeon. His specialty is rhinoplasty and he is credited with developing new surgical techniques to improve rhinoplasty results. As a talented surgeon and sought after speaker, Dr. Rohrich is invited to lecture on rhinoplasty at teaching seminars worldwide. He is co-editor of Dallas Rhinoplasty Nasal Surgery by the Masters and co-author of Secondary Rhinoplasty.

For more information about rhinoplasty revisional surgery, please view the "Frequently Asked Questions" or his "Resource Library" for related articles, websites and video clips.

* American Board of Plastic Surgery

Am I a good candidate for the surgery?

The best candidates for secondary rhinoplasty are individuals that are both emotionally and physically healthy as well as realistic about the potential for improvement. One with a secondary nasal problem should be looking for improvement, not perfection. Dr. Rohrich prefers to carefully evaluate the patient with a secondary nasal problem to assess their deformity and make sure the patient is realistic about the potential revision. Depending on the type of deformity, one may/may not totally improvement of the nasal shape or function. Deciding to have secondary nasal surgery should not be an impulsive decision but rather one that is carefully thought out. That is why it is important to be realistic, be informed and be true to yourself about what really bothers you about your results.

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What should I expect from my consultation?

During your secondary nasal surgery consultation, Dr. Rohrich will ask how you would like your nose improved. He will examine the inside and outside structure of your nose, and discuss the possibilities with you. He will also explain the factors that can influence the procedure and the results. These factors include the remaining structure of your nasal bones and cartilage, the shape of your face, the thickness of your skin, your age, and your expectations.

You will learn about the secondary nasal surgery, its limitations and risks, and discuss your needs and concerns. This will help Dr. Rohrich better understand your expectations and determine whether they can realistically be achieved. After your consultation a photographer will take photographs for your medical record and you will meet with Dr. Rohrich's patient coordinator to discuss surgery fees and schedule dates. You may also schedule an additional consultation to preview computer imaging. These may help you visualize the results of each technique that Dr. Rohrich has specifically designed for your surgery.

Be sure to tell Dr. Rohrich about all your previous nose surgery or if you suffered an injury to your nose, no matter how long ago it was. You should also advise him of any allergies or breathing difficulties, of any medications or vitamins you take, of recreational drug use, or if you smoke.

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How is the surgery performed?

The rhinoplasty surgery for secondary nasal deformity is called an “open approach”. The open approach, which Dr. Rohrich prefers, is performed by separating the skin of the nose from its supporting framework of bone and cartilage. This approach allows Dr. Rohrich to see the entire structure of the nose. He will then resculpt the nose to the desired shape. The nature of the sculpting will depend on the nature of your problem and Dr. Rohrich's preferred technique. There are an infinite number of techniques which can be utilized to sculpt the underlying framework when dealing with a secondary nasal revision. Dr. Rohrich prefers to use the patient’s own tissue (such as cartilage septum, ear or rib).

When the surgery is complete, a splint is applied to help your nose maintain its new shape. Soft plastic splints may also be placed in your nostrils to stabilize the septum and divide the wall between the air passages in order to improve your nasal airway.

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What happens the day of surgery?

Your secondary rhinoplasty surgery will be performed at either one of our specialty hospitals or an accredited outpatient surgery facility.

Prior to your surgery, oral medications are administered for your comfort and to lessen anxiety, as needed. General anesthesia is preferred for most plastic surgery procedures. You may be required to stay overnight in the hospital depending on the extent of your surgery. Secondary nasal surgery usually takes 2 to 3 hours to complete, although complicated procedures may take longer.

Be sure to arrange for someone to drive you home and stay with you to assist you the first couple of days while at home. The "Patient Care" section on this site gives instructions to prepare for surgery, including guidelines on eating, medications to avoid, drinking and smoking. If you are a smoker, you will be asked to stop smoking well in advance of surgery.

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What is the recovery like?

Immediately following your surgery, you will have a splint on the outside of your nose and a small gauze at the bottom of your nose. You will have some discomfort and/or pain following surgery. During the first twenty-four hours, your face will feel puffy, your nose may ache, and you may have a dull headache. While you are in the hospital your pain control is intravenous for the extent of your stay. You will be given prescriptions for pain medication and antibiotics as needed to take after your discharge.

You will notice that the swelling and bruising around your eyes will increase at first, reaching a peak after 2 to 3 days. Most of the swelling and bruising should disappear within two weeks or so. A little bleeding is common during the first few days following surgery and you may continue to feel some stuffiness for several weeks.

Your splint will be removed at about 5 to 7 days after surgery and your sutures will be removed after 7 to 10 days, sometimes sooner. Some bruising may persist for 2 to 3 weeks and you may tire easily. It is not uncommon for some patients to feel disappointed and depressed at first. By the third week, you'll look and feel much better. Most patients are back at work 1 to 2 weeks after surgery.

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What should I know about my results?

You will see final results at the top of your nose with a secondary nasal surgery at 9 to 12 months, and at the tip, between 12-15 months following surgery. After surgery, small burst blood vessels may appear as tiny red spots on the skin's surface. These are usually minor but may be permanent. As for scarring, when rhinoplasty is performed from inside the nose, there is no visible scarring. When an "open" technique is used, or when the procedure calls for the narrowing of flared nostrils, the small scars at the base of the nose or between the nostrils fade in time and are barely noticeable.

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What does the surgery cost?

At the time of your initial consultation you will be quoted a fee that will include Dr. Rohrich's surgery fee as well as hospital and anesthesia fees. Fees are due in full at least two weeks prior to your surgery. Checks, money orders, cash and credit cards may be used for payment. A $500.00 deposit will reserve a specific time and date for your surgery. If you have a deviated septum due to trauma or any breathing difficulties, insurance may sometimes cover the costs. Please be sure to bring your insurance information with you to your consultation appointment.

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