NOSE RESHAPING SURGERY

Revision Rhinoplasty

PROCEDURE

What is Revision Rhinoplasty?

Revision rhinoplasty is a specialised surgical procedure aimed at correcting or improving the results of previous nasal surgery. This operation is generally more complex than a primary rhinoplasty due to the presence of scar tissue, changes in nasal structure, and the need for precise corrections.

For patients undergoing another operation, often due to an unsatisfactory outcome from the initial surgery, it can also be an arduous process both mentally and emotionally.

Often, it involves the use of grafts from the patient’s own body, such as ear or rib cartilage, to rebuild or refine the nasal framework. Due to the intricate nature of revision procedures, patients can expect a longer recovery period compared to their initial surgery, as the nose needs more time to heal and settle into its final shape.

Nose reshaping surgery is one of the most complex plastic surgery procedures to perform and a revision rhinoplasty is typically more challenging than the primary procedure. Even a minor adjustment from the patient’s viewpoint, requires an advanced skill set and a highly customised approach as extensive scarring and loss of tissue structure can affect the outcome.

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Timing of revision rhinoplasty

The nose is a highly vascular area, so swelling is a significant factor in the post-surgery recovery period. Therefore, Mr Annakan Navaratnam recommends you wait for at least a year after your initial procedure before considering a revision rhinoplasty.

At 12 months, you’ll have a clear picture of your final aesthetic result.

Functional issues arising from a primary rhinoplasty can take even longer than a year to become a cause for concern.

Reasons to undergo revision rhinoplasty

There are several reasons why patients may wish to undergo this procedure, both aesthetic and functional and Mr Annakan Navaratnam will see the following issues during a revision rhinoplasty consultation:

Cosmetic reasons for revision rhinoplasty

Collapsed nasal bridge
Saddle nose deformity
Pollybeak deformity
Crooked or irregular nasal bridge
Inverted V deformity
The nose tip is asymmetrical
The nasal tip is too high
There is too much nostril show
A pinched nose or peg nose appearance
The nose is deviated
There is a persistent dorsal hump
A drooping nasal tip particularly when smiling
The nostrils are too arched
The nose is too long or short for the face
The nose projects forward too little or too much for the face
The nasal tip is too high / reveals too much of the nostrils (‘piggy nose’)

Functional reasons for revision rhinoplasty

Breathing difficulties through one or both nostrils
Difficulty sleeping
Restriction in exercise tolerance

At a glance

Surgery time

2.5 + (depends on complexity)

Anaesthetic

General

Time off work

2 weeks

Hospital stay

Day Case

Shower

After 1 day

Reasonable mobility

After 2 days

Exercise

After 6 weeks

Sleeping on back

4 weeks

Full recovery

6 – 8 weeks

Driving

2 weeks

Revision rhinoplasty results

MORE BEFORE & AFTERS

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RHINOPLASTY SPECIALIST

Mr Annakan Navaratnam

Annakan Navaratnam is a Consultant Ear, Nose & Throat (ENT) Surgeon whose private practice is based at Harrow and Welbeck Hospital in Central London and The Clementine Churchill Hospital in Harrow. In his NHS practice, he works at Royal National ENT Hospital, University College London Hospital (UCLH) and is an honorary consultant at Great Ormond Street Hospital.

He has a subspecialty interest in rhinology and facial plastic surgery, with particular expertise in septorhinoplasty and nose reshaping.

Annakan is excellently placed to manage general adult and paediatric ENT presentations and, in particular, is able to assess and treat complex problems related to the form and function of the nose. This includes endonasal (scarless) rhinoplasty, revision septorhinoplasty as well as advanced endoscopic sinus surgery.

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What to expect

Here you will find some essential information to help you prepare for surgery and the arrangements you should make to ensure you have the support you need and that everything runs smoothly on the day. However, we are on hand to answer any questions you may have.

01. The consultation

The first stage is always a comprehensive consultation and pre-operative assessment with your rhinoplasty surgeon Annakan Navaratnam.

During the consultation, he will listen carefully to your concerns and desired outcomes, and recommend whether surgery is appropriate at this time. The potential risks, post-surgery expectations, and recovery details of the specific procedure will also be discussed. A detailed medical history will be obtained to ensure your fitness for surgery.

Examination of the nose will be performed during the consultation to assess the nasal structures and to evaluate for any presence of nasal disease. This will often involve a procedure called nasoendoscopy to examine the deeper nasal anatomy.

Something investigations in the form of imaging such as a CT scan may be required as part of the assessment to help guide treatment. Pre-operative photographs are always necessary prior to rhinoplasty surgery and aid in the consultation process. These are taken during the consultation.

A two-week reflection period follows the initial consultation, during which you can return for additional consultations free of charge.

02. Preparing for surgery

If you decide to proceed, you’ll receive guidance on preparing for surgery. Pre-surgery tests may be required.

Mr Navaratnam will advise you on stopping smoking as far in advance of surgery as possible due to its impact on healing, infection risks, and complications during anaesthesia. Guidance on discontinuing blood-thinning medication and fasting before surgery will be provided.

03. Day of the procedure

Upon arrival at hospital, you’ll be escorted to a private room, and vital signs will be assessed. Your surgeon will finalise markings, and the anaesthetist will visit you. Clinical photography will document the pre-op and post-op phases.

The procedure is performed under general anaesthesia, followed by recovery in a specialist recovery room. Rhinoplasty surgery can be performed as a day case so once you have recovered sufficiently you will be discharged into the care of a friend or family member.

You will usually have an external nasal dressing over the nose and occasionally dressings inside the nostrils are required. These dressings are removed at your first post-operative follow-up appointment, which is usually 7-10 days after surgery.

04. Your recovery

Post-surgery pain varies for each individual, but most patients find it minimal and can be managed with over-the-counter painkillers. It typically subsides within the first week or so along with any bruising.

You will expect swelling and bruising around the eyes and cheeks following surgery which will subside in the days and weeks following surgery.

We advise that you do not undertake strenuous activity or exercise for 2 weeks after surgery. Also avoid hot drinks and hot showers for 2 weeks after surgery as this may increase the risk of bleeding.

A comprehensive recovery guide, including follow-up appointment dates, will be provided. Our team will be on hand if you have any concerns.

Frequently asked questions

How do I know if I need a revision rhinoplasty?

Signs worth discussing with a surgeon include ongoing breathing difficulties, visible asymmetry or irregularities, or a result that has changed or settled differently than expected as swelling resolved. As the nose can take up to a year to fully settle, Mr Navaratnam recommends waiting until this period has passed before assessing whether revision surgery is appropriate.

How do I choose the right surgeon for revision rhinoplasty?

Revision rhinoplasty is more technically demanding than primary surgery, so look for a surgeon with specific experience in revision cases, including complex grafting techniques. It’s also worth finding a surgeon you feel able to be open with, as an honest conversation about what went wrong and what’s achievable is central to a good outcome.

What is the difference between primary rhinoplasty and revision rhinoplasty?

A rhinoplasty is surgery to address the shape of the nose and achieve better harmony with the rest of the face. A revision rhinoplasty can be required to correct or improve on the results of the initial procedure. Although the function of the nose should always be considered in a primary rhinoplasty, it is often compromised; a secondary operation is required to address structural concerns.

There are also ageing changes to the nose that occur over time, and a secondary rhinoplasty may be desired to address these alterations.

Why is revision rhinoplasty more challenging than a primary rhinoplasty?

Revision rhinoplasty is typically a much more complex procedure. Many ENT, plastic or maxillofacial surgeons who offer primary rhinoplasty, will not perform revision rhinoplasty. It requires an advanced skill set and utilisation of a wide array of different techniques. You can’t use a one-size-fit-all for approach.

Revision rhinoplasty is also often a very emotionally draining process for the patient. You’ve gone through the unexpected outcome of the first surgery, and, in some cases, been left very disappointed that your nose looks worse than it did initially. Being able to trust the surgeon performing your revision rhinoplasty procedure can be challenging.

How long should I wait before a revision rhinoplasty?

Mr Annakan Navaratnam recommends you wait for at least a year after your initial procedure before considering a revision rhinoplasty. The nose can take 12 months or more to fully heal and for all swelling of the delicate nasal tissues to disappear. At that point, you will have a clear picture of your final result and if there are any concerns to address.

How many times can you have revision rhinoplasty?

There is no fixed limit, but each additional procedure becomes more complex as scar tissue builds and healthy cartilage becomes scarcer. Mr Navaratnam recommends keeping revisions to a minimum and allowing sufficient healing time between procedures to give each one the best chance of success.

What cartilage grafts are used in revision rhinoplasty?

When the nose’s own cartilage has been depleted by previous surgery, Mr Navaratnam may use cartilage taken from the ear or rib to rebuild or reinforce the nasal framework. Additionally, there is the option of a cadaveric rib graft, which is donated by patients for medical research and treatment. The choice of graft depends on how much structural support is needed, and this will be discussed in detail at consultation.

What are the risks of revision rhinoplasty?

Revision rhinoplasty typically has a higher risk of complications than the initial procedure. These include more extensive scarring, temporary or permanent loss of sensation, bleeding, and there is also a higher risk of infection after secondary rhinoplasty. There is also a risk of an unsatisfactory result, as certain factors related to the primary procedure will affect what can be achieved.

Can a revision rhinoplasty achieve the results I want?

Realistic expectations are essential, as factors such as skin thickness, scar tissue, and the structure of the nasal bones and cartilage will affect what is achievable.

Revision rhinoplasty, in general, is a shared decision between the surgeon and the patient. Unfortunately, it’s not always possible for the surgeon to achieve exactly what the patient wants. The surgeon must clearly explain what went wrong previously and what is and is not possible, then devise an approach that works for both the patient and the surgeon to achieve the desired result.

How much does revision rhinoplasty cost?

Revision rhinoplasty is generally more expensive than a primary procedure, reflecting the added complexity, planning, and any required cartilage grafting. Because every case is different, an accurate cost can only be given after Mr Navaratnam has assessed your nasal structure and previous surgery at consultation. Please visit our pricing page for a guide to our rhinoplasty costs.

Is revision rhinoplasty covered by insurance if my original surgery was private?

Cosmetic revisions are not usually covered by private medical insurance. If the revision is needed primarily to correct a functional problem, such as breathing difficulty, some insurers may consider covering that element, though this varies by provider and policy. It’s worth checking directly with your insurer ahead of any consultation.