logo

Call Us

+65 6778 8648
contact us

Revision Rhinoplasty

Revision rhinoplasty is a surgical procedure designed to correct or enhance the outcomes of a prior rhinoplasty. It addresses both cosmetic and functional concerns for individuals who are dissatisfied with their initial surgery.

Often more complex than primary rhinoplasty, it requires advanced surgical expertise to manage issues such as scar tissue, altered nasal anatomy, and complications from previous surgeries. A thorough consultation, including 3D imaging and an in-depth discussion of goals, helps establish realistic expectations and minimise the likelihood of further revisions.

doctor img
Dr Terence Goh

MBBS

MMed

MRCS

FAMS

Revision+Rhinoplasty-banner Revision+Rhinoplasty-banner

Indications for Revision Rhinoplasty

Revision rhinoplasty can address a variety of aesthetic and functional concerns that may arise after the initial surgery.

  • Functional Issues

    Breathing difficulties or nasal obstruction caused by structural changes from the first surgery can be resolved, improving airflow and nasal function.

  • Contracted Nose Reconstruction

    Cases of nasal contraction need scar release, skin stretching, and structural rebuilding using robust cartilage grafts, often sourced from the patient’s rib or a cadaveric rib.

  • Nasal Proportion Adjustments

    Adjustments to the bridge, tip, or nostrils restore balance between the nose and facial features while preserving a natural appearance.

  • Complications from Implants

    Problems like implant deviation, prominence, excessive length, or infection may require repositioning, replacement, or scar release.

  • Aesthetic Concerns

    Revision rhinoplasty focuses on resolving cosmetic issues such as asymmetry, over-reduction, under-correction, or an unnatural appearance. It can address a pinched or retracted nasal tip, asymmetry, or irregularities in the bridge to enhance facial balance.

  • Complex Reconstructive Needs

    Advanced cases, like soft tissue defects or structural loss, may require staged surgeries with fat grafts, skin grafts, or cartilage grafts to restore the nasal framework.

revision rhino-plan -m

Customised Plan for Revision Rhinoplasty

We have a solution for every complication.

Deviated or Noticeable Implant

Deviated or prominent implants often result from improper pocket creation, unsuitable implant size or shape, or other factors causing displacement. For example, an implant that is too long or an L-shaped implant can lead to nasal tip prominence or an unnatural appearance.

The revision plan involves redesigning the implant and recreating the pocket to properly realign the implant. If an L-shaped implant was used, it can be replaced with an I-shaped implant or autologous implant. In cases of infection, the implant must be removed and a staged re-insertion is planned.

Alternatively, autologous tissue can be used to reconstruct the nasal dorsum, eliminating the need for synthetic implants (autologous rhinoplasty).

Deviated or Asymmetrical Nose

In some cases, an undetected septal deviation or underlying asymmetry may cause the nose to appear deviated or asymmetrical after surgery.

The workup for such cases usually requires a detailed scan to evaluate the position of nasal structures. The surgical plan involves correcting the septal deviation to ensure proper alignment before proceeding with the revision rhinoplasty.

Recurrence of Hump Nose

Recurrent hump nose can occur due to regrowth of bone or cartilage, absorption of fascia used to cover the nasal hump, or incomplete correction of hook nose during the initial surgery.

The surgical plan involves performing hump removal surgery and covering the area with a fascia graft to smooth the nasal profile. Alternatively, increasing nasal tip projection and dorsal augmentation may be used to conceal the hump and improve overall aesthetics.

Dissatisfaction with the Nose Line

Dissatisfaction with the nose line often stems from a nasal bridge that is too high, too low, or affected by a prominent implant.

The revision surgery focuses on reshaping the nasal bridge to recreate a balanced and aesthetically pleasing nose line.

Skin Damage or Tissue Loss

Damage to the skin or tissue is one of the most challenging complications to correct. This can result from implant exposure leading to infection, tissue loss due to infection or blood supply damage, or capsular contracture causing a shortened nose.

Revision surgery for these complications is considered Reconstructive Surgery of the Nose. Large amounts of autologous cartilage from the rib are often required to rebuild a strong and stable nasal framework. For cases involving missing skin, local or regional tissue flaps may be needed to reconstruct the missing components.

Total autologous rhinoplasty is the gold standard for addressing these complex deformities, ensuring that no foreign material remains in the nose.

Nasal Congestion After Primary Rhinoplasty

Nasal congestion after rhinoplasty can occur if the primary cause of congestion was not identified during the initial surgery, if surgical complications led to airway obstruction, or if there was a collapse of the internal or external nasal valves.

The surgical plan includes septoplasty to correct a deviated septum and the use of spreader grafts to support and open the internal nasal valves. Nostril-plasty may also be performed to address the collapse of external nasal valves and restore proper airflow.

Revision Rhinoplasty Techniques

A range of surgical techniques is used in revision rhinoplasty, each tailored to address specific issues and improve both function and aesthetics.

Scar Tissue Management

Contracted noses or scarred nasal tips require removal or adjustment of excessive scar tissue from the previous surgery. This enhances contouring and allows for better healing.

Cartilage Grafting

In cases of asymmetry or deviation, revision rhinoplasty often requires the reconstruction of a nasal support. Structural support is restored or enhanced using cartilage from the ear, rib, or septum, especially in cases of nasal collapse or deformities.

Bridge Refinement

The nasal bridge is adjusted to improve symmetry, smooth irregularities, or correct over-reduction or over-projection.

Tip Reconstruction

Techniques are employed to restore a natural and proportional nasal tip, addressing pinching, asymmetry, or drooping.

Septoplasty

A deviated septum uncorrected or worsened in the previous surgery is aligned to improve airflow and nasal function.

Osteotomies

Controlled reshaping of nasal bones achieves a more symmetrical appearance and corrects irregularities.

Levels of Complexity in Revision Rhinoplasty

Revision rhinoplasty procedures are categorised based on the complexity of the required adjustments. This classification helps determine the surgical approach and techniques to address individual needs effectively.

  • Minor Revisions

    These involve small-scale corrections, such as releasing scar tissue to adjust implant positioning or making minor tip adjustments for symmetry. Cartilage grafts may also be used to refine subtle irregularities.

  • Intermediate Revisions

    Structural adjustments such as correcting a deviated septum or addressing moderate nasal asymmetry fall under this category. These revisions may involve cartilage grafting and septoplasty.

  • Major Revisions

    Extensive procedures addressing complex issues like infected implants, a contracted nose, or significant tissue loss. They often require implant removal, scar tissue release, and reconstruction with rib cartilage or biocompatible materials.

Rhinoplasty Materials: Options for Revision Procedures

Revision rhinoplasty is similar to rebuilding the nose and often requires new materials.

Various materials are available for revision rhinoplasty, each with distinct characteristics, advantages, and considerations.

alloplastic implant

Silicone
Silicone is one of the oldest and most commonly used implants in rhinoplasty. It retains its shape over time and does not get absorbed. Its rigidity makes it ideal for creating smooth, curved lines. However, adequate skin coverage is necessary to prevent complications. Capsular contracture, a potential issue, can lead to a shortened nose over time.

Gore-Tex
Gore-Tex integrates well with natural tissue due to its porous texture, making it suitable for patients with thin skin and resulting in a natural appearance post-surgery. However, it is more challenging to remove and can shift downward due to tissue integration.

diced cartilage

Diced Cartilage + Glue
Finely diced cartilage, mixed with tissue glue, forms a bioactive paste used for smoothing minor irregularities or slightly elevating the nasal dorsum. Cartilage can be sourced from the septum or ear. However, resorption may lead to a reduction in dorsal height over time.

Diced Cartilage + Fascia
Diced cartilage is wrapped in fascia harvested from the scalp via a hidden incision. This approach maximises cartilage utilisation for full dorsal augmentation while minimising irregularities and deviations. Resorption rates are low due to the protective fascia wrapping.

Fascia Only
Fascia-only grafts are used for augmenting the radix or thickening the noses of patients with very thin skin. This option avoids the need for cartilage and provides subtle augmentation.

dermal graft

Dermal grafts can be harvested from various body areas, with the lower back or buttock being a common choice due to the well-hidden scar. The graft, comprising skin and fat, enhances the nose’s appearance without the need for synthetic implants. However, a 20–30% resorption rate may occur.

rib cartilage

Rib cartilage is considered the gold standard due to its abundant supply. It can be used either en bloc (as a single piece) for reconstructive purposes requiring significant volume or diced and wrapped in fascia for augmentation. Rib cartilage offers versatility but involves a more invasive procedure, often requiring an overnight hospital stay. It is also the most expensive option.

With improved tissue preservation, cadaveric cartilage is now becoming a reliable option for patients who wish to avoid additional surgical sites for autograft harvesting or lack sufficient cartilage from their own body.

3D Implants for Revision Rhinoplasty

3D custom implants offer an effective solution for addressing complications from previous rhinoplasties involving implants. For patients experiencing nasal deviation or structural irregularities, these implants provide several key advantages.

  • Enhanced Precision and Accuracy

    3D implants are custom-designed based on the patient’s unique anatomy using specialised imaging technology. This ensures an optimal fit and accurate correction of specific deviations that occurred with previous implants.

  • Improved Structural Support

    When previous implants have resulted in deviation or structural compromise, 3D implants provide targeted support exactly where needed. Their customised nature allows for varying densities and contours to counterbalance existing asymmetries.

  • Reduced Risk of Recurrent Complications

    The precise fit of 3D implants reduces the likelihood of shifting, rotation, or migration—common issues with standard implants that often lead to deviation. This stability results in more predictable, lasting outcomes and decreases the need for additional revisions.

  • Seamless Integration

    3D implants can be designed to integrate harmoniously with existing nasal structures and any remaining previous implant material. This creates a more natural appearance and feel while effectively correcting complications from earlier procedures.

Ready for Natural Looking Results?

Consult our MOH-accredited plastic surgeon for a personalised treatment plan.

Make an Enquiry
Image callout2

Preparing for the Procedure

Consultation

A detailed evaluation of the nasal structure and facial proportions is conducted to create a personalised surgical plan. Specialised tools such as pre-operative 3D imaging and scans provide a clear visualisation of potential outcomes, ensuring alignment between the patient’s goals and realistic expectations. These scans also assist in planning customised 3D-printed implants, if needed.

Medical Evaluation

As part of the pre-operative process, overall health is assessed by reviewing previous surgeries, current medications, and any underlying medical conditions. This comprehensive evaluation helps identify potential risk factors and ensures the surgical plan is tailored to your individual needs.

Pre-Surgical Guidelines

Patients are advised to avoid blood-thinning medications, supplements, and smoking for at least two weeks before surgery. These precautions reduce the risk of complications and support optimal healing. Pre-operative medical testing or imaging may also be performed to further assess nasal anatomy and address any functional concerns.

Step-by-Step Procedure

1. Anaesthesia Administration

Most revision rhinoplasty procedures are performed under general anaesthesia due to their complexity. For minor revisions, such as scar release or small adjustments, local anaesthesia with sedation may occasionally be used.

2. Surgical Process

  • Making Incisions: The procedure typically uses the open rhinoplasty technique, which involves a small external incision on the columella. This approach provides better access to altered structures from previous surgeries. In select cases, a closed rhinoplasty technique, with all incisions inside the nostrils, may be used if the required adjustments are minimal.
  • Scar Tissue Removal and Reshaping: Excessive scar tissue from the previous surgery is carefully removed or adjusted to improve contour and allow smoother reshaping of the nasal structures.
  • Cartilage Grafting and Structural Support: Cartilage from the ear, rib, or septum is used to rebuild or enhance structural integrity, particularly for areas compromised by previous surgeries or deformities.
  • Bridge Refinement: Adjustments are made to smooth irregularities, improve symmetry, or address issues such as over-reduction or excessive projection caused by prior procedures.
  • Tip and Nostril Refinement: The nasal tip and nostrils are reshaped to restore proportion and alignment. Concerns such as a pinched, retracted, or bulbous tip are carefully addressed to create a more balanced appearance.
  • Functional Adjustments: If needed, structural corrections, such as addressing a deviated septum, collapsed nasal valves, or excessive scarring, are performed to improve breathing alongside aesthetic changes.

3. Closure and Dressing

After reshaping, the incisions are sutured, and a splint is applied to support the nose during the initial healing phase. In some cases, additional soft tissue support, such as nasal packing, may be used to stabilise internal structures.

Post-Surgical Care and Recovery

Immediate Post-Surgery Care

Nasal packing, if used, is removed within 48 hours. Sutures, whether internal or external, are typically taken out after 5–7 days. Splints may be changed on the fifth day and are usually retained for up to 10 days to provide stability.

Swelling Management

Initial swelling begins to subside within 10–14 days, while more noticeable improvements occur within 1–2 months. It may take 4–6 months for the final results to become apparent as residual swelling gradually diminishes.

Recovery Process

Most patients can return to non-strenuous activities, including work, within 1–2 weeks. Strenuous activities, heavy lifting, or direct pressure on the nose should be avoided until full recovery allows for it.

Aftercare Recommendations

Patients should keep their head elevated during sleep, avoid sun exposure to minimise swelling and discolouration, and follow up regularly with their surgeon to monitor the healing process and address any concerns.

Potential Risks and Complications

As with any surgery, reduction rhinoplasty carries potential risks. Common side effects include swelling, bruising, and temporary numbness, which generally resolve as the healing process progresses. Rare complications may include infection, bleeding, scarring, asymmetry, changes in sensation, or dissatisfaction with the aesthetic outcome. In some cases, revision surgery may be necessary to address concerns or refine the results further. Functional issues, such as persistent congestion, can occur but are typically manageable with appropriate aftercare and follow-up consultations.

Frequently Asked Questions (FAQ)

What should I expect during recovery compared to my first rhinoplasty?

Recovery after revision rhinoplasty may take longer due to the presence of scar tissue and the complexity of the procedure. Swelling can be more persistent, and final results may take up to 12 to 18 months to fully develop.

Is it harder to achieve natural-looking results with revision rhinoplasty?

Achieving natural results can be challenging due to altered anatomy and scar tissue. However, with advanced techniques and an experienced surgeon, aesthetically pleasing and functional outcomes are possible.

Are there limitations to what revision rhinoplasty can achieve?

Yes, anatomical constraints and previous surgical changes can limit what is achievable. A thorough consultation helps define realistic expectations.

Does revision rhinoplasty have a higher risk of complications than primary rhinoplasty?

Revision rhinoplasty carries an increased risk of complications due to scar tissue and changes from previous surgeries. These risks can be minimised with careful planning and a skilled surgeon.

Is there a maximum number of revisions a person can have?

There is no absolute limit, but each subsequent surgery becomes more complex and may have diminishing returns. Surgeons carefully evaluate whether further revisions are advisable.

Image Frame 1854

Dr Terence Goh

Choosing to combine the intricate skills of microsurgery with aesthetic surgery, Dr Goh specialises in gynaecomastia, surgery of the Asian face, particularly Asian eyelid surgery and rhinoplasty.

Blending the precision of microsurgery with the artistry of aesthetic surgery, Dr Goh has a special interest in gynaecomastia, facial procedures, including ptosis and eyelid surgery, as well as rhinoplasty.

He also offers a full range of body contouring procedures such as mummy makeovers, breast augmentation, liposuction, and body sculpting—designed to help patients feel more confident and comfortable in their own skin.

Beyond aesthetics, Dr Goh remains active in reconstructive microsurgery, with expertise in breast reconstruction, head and neck reconstruction, and lower limb salvage—restoring both form and function where it’s needed most.

  • Bachelor of Medicine, Bachelor of Surgery, National University of Singapore
  • Master of Medicine, National University of Singapore
  • Member of the Royal College of Surgeons
  • Fellow of the Academy of Medicine, Singapore (Plastic Surgery)
Read Full Bio

Make an Enquiry

Got a Question? Fill up the form and we will get back to you shortly.

    For faster enquiry, call us!+65 6778 8648

    Azataca-AZATACA Plastic Surgery (NOVENA)

    AZATACA Plastic Surgery (NOVENA)

    Royal Square Medical Centre
    101 Irrawaddy Rd, #14-09
    Singapore 329565
    Mon - Fri 9:00am - 6:00pm
    Sat 9:00am - 1:00pm
    Sun & PH Closed
    +6567788648
    AZATACA Plastic Surgery (ORCHARD)

    AZATACA Plastic Surgery (GLENEAGLES)

    Gleneagles Medical Centre
    6 Napier Road #03-17
    Singapore 258499
    Mon - Fri 9:00am - 5:00pm
    Sat 9:00am - 1:00pm
    Sun & PH Closed
    +6567671648