Secondary rhinoplasty in Paris 16 — revising a nose already operated on

A secondary rhinoplasty is not a second rhinoplasty. It is an operation of another kind, on a nose whose landmarks have been altered, whose skin has healed over a new framework, and whose cartilage available for reconstruction may be lacking.

People who come about a revision have one thing in common: they have already trusted someone once. They arrive with a disappointment, often with wariness, sometimes with anger. That is part of the consultation, and it takes time.

I do not comment on the work of the colleague who operated before me. This is not merely a rule of professional courtesy written into the code of medical ethics: it is that one does not judge an operation one did not attend, on a nose whose starting state one never saw. What interests me is what can be corrected today.

What is a secondary rhinoplasty?

It is the surgical revision of a nose that has already undergone a rhinoplasty, whoever the operator was.

It must be distinguished from a touch-up. A touch-up corrects a detail on a result that is broadly achieved — a small irregularity, a limited asymmetry — and is carried out on an anatomy the surgeon knows because he created it himself. A secondary rhinoplasty takes on an entire architecture, often long afterwards, and without knowing its history.

Why is a revision more difficult?

Four reasons combine, and they explain why both operating time and analysis time are longer than at first intention.

The tissue planes have gone. An unoperated nose is dissected in natural spaces. An operated nose is crossed by scar tissue that adheres, bleeds more, and makes every step less predictable.

The cartilage stock has been drawn on. The septum, the main reserve, has often already been harvested. Rebuilding a support then means finding cartilage elsewhere.

The skin has changed. It has lost part of its elasticity and of its blood supply. Thin, retracted skin after several operations drapes poorly over a rebuilt framework.

The deformity is structural, not cosmetic. An over-resected dorsum, a pinched tip, a collapsed valve are not corrected by removing more: material has to be put back. Secondary surgery is almost always additive surgery, whereas the first was subtractive.

What leads to a revision?

Requests fall into three families, and the distinction is not academic: it changes the outlook entirely.

Deformities of shape

A residual or recurrent hump, an over-hollowed dorsum, visible or palpable irregularities, a visible junction between the bony walls, a pinched or conversely widened tip, asymmetry of the tip or of the nostrils, an angle with the lip too open or too closed, fullness above the tip.

Breathing difficulties

They are frequent after a large reduction and often overlooked in the initial request, because the person consults about appearance. Collapse of a valve, a residual deviation or scar retraction can obstruct a nose that breathed before the operation. This functional component must be looked for systematically.

Disappointment with no abnormality found

Sometimes examination finds no defect proportionate to the distress expressed. These situations call for particular caution: operating again does not resolve them and can make them worse. Saying so is more useful than agreeing.

What should you bring to the consultation?

Three items change the quality of the analysis, and it is useful to gather them before the appointment:

• the operative report of the previous operation or operations, which states what was removed and what was put in;
• photographs from before the first operation, which show the starting point;
• the precise dates of the operations and of any touch-up.

These documents belong to you and you may ask the practitioner who operated on you for them. Without them the analysis remains possible, but it rests more on examination and on imaging.

Where does the cartilage for reconstruction come from?

Where septum remains, that is what is used: it is the best-suited cartilage, and taking it adds no scar. Where it has already been harvested, cartilage comes from the conchal bowl of the ear, through an incision hidden behind the auricle.

Costal harvesting is not part of my practice. Where a reconstruction would require it, I say so and refer to a team that does perform it: a frank opinion is worth more than an operation carried out with insufficient means.

Who this procedure suits — and who it does not

It suits a person whose difficulty is identifiable on examination, who understands that a revision aims at improvement and not at a new nose, and whose last operation was at least a year ago.

It does not suit where that interval has not elapsed, where the expectation concerns a result the available anatomy cannot reach, where the request changes at every consultation, or where the distress expressed is out of proportion with what examination finds. In that last situation surgical revision most often makes the difficulty worse: directing the person towards appropriate support is part of care.

A proportion of revision requests ends in advice to abstain. That is not a refusal to take someone on: it is the outcome of the analysis, and it is said to your face.

Limits and specific risks

All the risks of a rhinoplasty apply, and two of them are increased.

The healing and vascular risk is higher on skin already operated on, particularly after several operations. Smoking, here, is not one factor among others: it is the leading avoidable cause of skin complication, and stopping conditions whether the operation is feasible at all.

The rate of further revision is higher than after a first operation, across all teams. A revision brings an improvement; it rarely gives back the nose the person would have had if the first operation had gone otherwise.

Finally the result is judged later: scarred skin settles more slowly, and at least a year must be allowed, often more.

How is the operation carried out?

Under general anaesthetic, with one night in hospital in most cases. It lasts longer than a first-intention rhinoplasty, because of the scar dissection and of any cartilage harvest.

The open approach is more often necessary than at first intention: it gives the exposure a reconstruction requires, and the short scar on the columella usually fades very well.

When is the result final?

At least one year, often eighteen months. Scarred skin settles more slowly, and judging a revision calls for more patience than judging a first rhinoplasty.

No further operation is considered before that point.

The interval before flying is longer than after a first rhinoplasty, particularly where a cartilage graft has been needed: it may reach four to six weeks for a long-haul flight. If you are coming from abroad, this is settled before booking.

Is secondary rhinoplasty reimbursed?

A revision carried out for aesthetic reasons is not reimbursed by French health insurance.

Where the revision corrects a documented breathing difficulty — valve collapse, residual deviation — the functional component may be eligible for partial reimbursement, after prior authorisation. The conditions are examined at the consultation.

Frequently asked questions

How long must one wait after the first operation?

One year at least. This interval is not an administrative precaution: swelling and fibrosis are still changing, and operating too early means correcting a state that is not the final result.

Can the nose one had before the first operation be recovered?

No. What was removed cannot be put back identically, and the skin has changed. A revision aims to correct what is troublesome today, not to go back in time. That is the first expectation to adjust, and I prefer to say so at the first consultation.

Should one go back to the surgeon who operated?

That is often the first instinct, and it is a legitimate one: he knows what he did, and a touch-up by him is sometimes the simplest solution. Consulting another practitioner for a second opinion is equally legitimate, and commits you to nothing.

Does a revision cost more?

It is longer, more complex, and may require a cartilage harvest. The written quotation, given at the consultation, takes this into account and itemises each element. The statutory fifteen-day reflection period applies as for any aesthetic operation.

How many times can a nose be revised?

There is no theoretical maximum, but each further operation reduces the available resources — cartilage, skin quality, blood supply — and diminishes the expected benefit. That is one more reason to revise only on a clear indication.

Last updated: August 2026 · Medical content reviewed by Dr Benjamin Pulvermacker, qualified plastic surgeon in Paris 16.

How is follow-up organised after a revision?

A revision is watched more closely than a first operation: the tissues have been operated on before, they behave less predictably, and swelling tends to settle in for longer. The rhythm of consultations remains that of the practice — one within seven days, one between day ten and day fourteen — but it is tightened as far as progress requires. Nurses deliver local care, the anaesthetist follows pain relief, and both manual lymphatic drainage and hyperbaric oxygen are offered where indicated. See post-operative care.