Revision Rhinoplasty Surgery: What You Need to Know

Pros

• Revision surgery can improve your nasal appearance or resolve functional issues like breathing problems.
• It's an outpatient procedure, and recovery isn't too painful.
• A good result from a secondary procedure can create more balance in your facial features, relieve appearance-related anxiety, and boost self-confidence.
• Any scarring will fade and should become difficult to detect.

Cons

• Revision rhinoplasty is widely known as one of the most technically challenging facial plastic surgery procedures, requiring meticulous surgical techniques and a keen eye. “There are circumstances where revision rhinoplasty can actually cause more damage than good, so it’s important to seek a skilled, board-certified plastic surgeon who’s able to identify what’s best for you,” says Dr. Barry Weintraub, a board-certified plastic surgeon in New York City.
• You’ll need up to 10 days of downtime after this nose surgery, due to bruising and swelling. 
• It takes at least a year for all the swelling to resolve so you can see your final result.
• The outcome may not live up to your expectations. 
• Because it’s so challenging, rhinoplasty revision surgery typically costs more than the previous surgery—especially if you don't want to return to your primary surgeon or they don't offer a price break on revisions.

RealSelf Tip: A 2021 article published in Aesthetic Plastic Surgery reported that approximately a third of all candidates for rhinoplasty surgery were diagnosed with body dysmorphic disorder (BDD). It also noted that these patients “commonly have high expectations regarding the surgical outcome and are often not satisfied postoperatively.”

Your surgeon may look for signs of BDD, to help assess whether you’re a good candidate for a secondary procedure. If they believe you have severe BDD, they may decline you as a patient and refer you for counseling.

• Average Cost:
• $15,929

• Range:
• $5,600 - $30,000

If your rhinoplasty revision involves just a minor tweak, it may cost less than the original procedure—if it’s performed by your original surgeon. Some surgeons even offer their primary rhinoplasty patients “free” revision surgery, with a small fee for the surgical facility and anesthesia.

If the nose has multiple major issues, such as prominent deviation and drooping nasal tip, it will likely require nasal reconstruction surgery, according to Dr. Shah. Nasal reconstruction costs substantially more than a primary rhinoplasty, due to the time and technical difficulty involved. In this case, it’s wise to find the best revision rhinoplasty surgeon you can afford, to help avoid the possibility of another (more complicated and costly) revision procedure in the future.

Most revision rhinoplasties are considered cosmetic surgery and not covered by insurance. But if the airway is compromised because of valve collapse or a deviated septum, your insurance may cover a portion of the cost.

That said, not all revision rhinoplasty surgeons accept insurance. “Because revision rhinoplasties are so difficult to perform and often the insurance reimbursement is minimal, many top, experienced surgeons will not accept insurance,” says Dr. Toledo. Even if they do, you may find that you'll have significant out-of-pocket costs. 

However, most plastic surgeons do offer payment plans or accept third-party financing options, such as CareCredit.

See our complete guide to revision rhinoplasty costs

The revision rhinoplasty photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Facial plastic surgeons recommend waiting at least a year for swelling to go down and minor asymmetries to improve before considering a revision.

“Some of the biggest disasters I’ve seen in revision rhinoplasty consultations have come after revision surgery was attempted too soon,” says Dr. Steven Pearlman, a board-certified facial plastic surgeon in New York City.

That said, many doctors on RealSelf say that they’ve performed revisions earlier on good candidates, in special situations. 

While you’re waiting, think twice before being tempted to have a “liquid” or nonsurgical rhinoplasty with dermal filler as a short-term fix. “Nonsurgical rhinoplasty will distort the normal anatomy for your revision surgeon,” says Dr. William Portuese, a board-certified facial plastic surgeon in Seattle. “In addition, nonsurgical rhinoplasty is not FDA-approved, and it can have significant complications.”

This delicate procedure is usually performed under general anesthesia, with the patient fully asleep. It can take between 90 minutes and five hours, depending on the complexity of your situation and surgeon’s technique.

Most rhinoplasty surgeons use the open approach, which allows better visibility to assess the state of the nasal tissue and easier access to reconstruct your nose. Here’s how that works:

• After making a small incision in the columella between the nostrils and additional incisions inside the base of the nostrils, your surgeon will separate the skin from the cartilage and bone.
• Then they'll reshape your nose. This may require cutting and repositioning bone (commonly referred to as “breaking the nose”) or removing bone and cartilage—though most likely, cartilage grafts will need to be added, to better support your new nose.
• The new cartilage is often taken from the nasal septum, ear, or rib. “Revision rhinoplasty is often a delicate balance between subtracting excess tissues and adding to tissues which may have been overly removed in the first surgery,” explains Dr. Shah.
• Once the underlying structure of your nose is refined, the skin is gently re-draped, the nasal tip is carefully aligned, and the tissue is affixed with tiny sutures. 

You’ll head home as soon as you recover from the anesthesia. Make sure you have someone you trust there to make sure you get home safely.

In most cases, revision rhinoplasty surgeons prefer to open the nose so they can clearly see how the anatomy was altered during a previous surgery. This is especially true when the surgeon performing the revision rhino did not perform the primary surgery.

That said, the less-invasive closed rhinoplasty (endonasal) technique can be used for less complicated cases of corrective nasal surgery. You’ll find out at your initial consultation if this option would work in your situation. 

Many surgeons perform closed revision nose jobs for even minor touch-ups under general anesthesia, to ensure that patients remain comfortable. “There are lots of nerve endings in the nose,” says Dr. Portuese. However, Dr. Shah notes that smaller “tweaks” like nostril adjustments or nasal hump reduction can be performed comfortably under local anesthesia.

Healing after nasal reconstructive surgery does take longer in most cases—especially if the procedure was done via an open approach. 

“Revision rhinoplasty healing time is longer because the scar tissue from the initial rhinoplasty slows the resolution of surgical swelling. If the changes are minimal, then swelling may resolve more quickly—but if a moderate or extensive amount of work is required, then a longer healing time should be anticipated,” says Dr. Thomas Kaniff, a board-certified facial plastic surgeon in Sacramento, California. 

Barring prolonged swelling, a longer recovery isn’t necessarily a tougher recovery. In fact, revision rhinoplasty recovery is similar to what you've experienced after a primary rhinoplasty.

• Bruising, swelling, and discomfort or a feeling of stuffiness are common, especially during the first two weeks post-op.
• Initially, your nose will be supported with a splint and bandages, to keep the nasal structures properly aligned. During the first week post-op, this dressing must be kept in place. 
• Most patients can return to work 7 to 10 days after a secondary rhinoplasty, but it’s important to avoid situations where your nose can be hit or jostled. 
• You'll have follow-up appointments so your surgeon can assess how your healing is progressing.

“Nasal bones take about two weeks to start gelling in place after surgery, but they’re not at their strongest for two to three months after surgery,” says Dr. Manish Shah, a plastic surgeon in Denver.

Every surgeon has different aftercare instructions and restrictions. Follow your surgeon’s post-op guidelines to a tee to prevent complications and speed healing.

Related: 8 Rhinoplasty Recovery Rules You Should Always Follow After Surgery