rhinoplasty.cc
Menu

Revision

A normal profile and six post-rhinoplasty deformities: polly-beak, saddle nose, inverted-V, open roof, pinched tip, alar retraction
A normal profile and six post-rhinoplasty deformities: polly-beak, saddle nose, inverted-V, open roof, pinched tip, alar retraction. Illustration: rhinoplasty.cc, checked against Gray's Anatomy plates 852–855; surgeon review pending.
Lateral crural strut graft: a weak, buckled lateral crus with external valve collapse, then the strut sutured to the deep (vestibular) surface of the lateral crus out toward the piriform aperture
Lateral crural strut graft: a weak, buckled lateral crus with external valve collapse, then the strut sutured to the deep (vestibular) surface of the lateral crus out toward the piriform aperture. Illustration: rhinoplasty.cc, checked against Gray's Anatomy plates 852–855; surgeon review pending.
Alar rim graft: a ~12 × 2 mm cartilage strip placed through the marginal incision in a pocket along the nostril rim, caudal to the lateral crus, with a cross-section of the rim showing the graft and the retracted rim without it
Alar rim graft: a ~12 × 2 mm cartilage strip placed through the marginal incision in a pocket along the nostril rim, caudal to the lateral crus, with a cross-section of the rim showing the graft and the retracted rim without it. Illustration: rhinoplasty.cc, checked against Gray's Anatomy plates 852–855; surgeon review pending.
Frontal view of the nasal skeleton: normal dorsal aesthetic lines and keystone, the open roof with the nasal bones separated, and the inverted-V with the upper lateral cartilages collapsed below the bones
Frontal view of the nasal skeleton: normal dorsal aesthetic lines and keystone, the open roof with the nasal bones separated, and the inverted-V with the upper lateral cartilages collapsed below the bones. Illustration: rhinoplasty.cc, checked against Gray's Anatomy plates 852–855; surgeon review pending.

Two-sentence lead. Secondary rhinoplasty corrects deformities left by a previous rhinoplasty: displaced or distorted structures, under-resection, or over-resection. In Guyuron's series of 100 consecutive revision patients the leading complaint was airway obstruction (65%), and the surgeon found more deformities than the patient reported.

The evidence, in the authors' words

  • Definition (Cochran & Gunter 2010): "Postoperative rhinoplasty deformities—such as displacement or distortion of anatomic structures, inadequate surgery resulting in under-resection of the nasal framework, or over-resection caused by overzealous surgery—require a secondary rhinoplasty. Success in secondary rhinoplasty, therefore, relies on an accurate clinical diagnosis and analysis of the nasal deformities, a thorough operative plan to address each abnormality, and a meticulous surgical technique. Septal cartilage is the grafting material of choice for rhinoplasty; however, auricular cartilage and rib cartilage are used in secondary rhinoplasty."
  • What revision patients present with (Lee, Zwiebel, Guyuron 2013, n = 100, mean age 39.2, all operated elsewhere): complaints — airway occlusion 65%, dorsum asymmetry 33%, nostril asymmetry 18%, tip asymmetry 14%. Surgeon's findings — dorsal asymmetry 65%, wide dorsum 47%, nostril asymmetry 41%, wide alar base 38%, dorsal hump 30%; "The senior author saw significantly more nasal deformities than the patients themselves". Maneuvers — septoplasty 71%, alar rim graft 67%, dorsal graft 63%, osteotomy 60%, dorsal hump removal 46%. "The high incidence of airway concerns among secondary rhinoplasty patients is alarming and emphasizes the urgent need to pay attention to the airway during primary rhinoplasty."
  • Sequelae of hump reduction (Rohrich 2004): "long-term dorsal irregularities caused by uneven resection or overresection or underresection…; the inverted-V deformity; and excessive narrowing of the midvault."
  • Revision rates in a 1,191-case dorsal-preservation series (Saban 2026): 3.4% → 9.9% (over-extended indications) → 3.3% after a unified framework.
  • The approach: the external approach was introduced for secondary cases first (Gunter & Rohrich 1987). Sheen's "Secondary rhinoplasty" (PRS 1975) is the closed-approach counterpart.

Complication pages the hub links to (each page: definition, cause, fix, who publishes on it)

Slug Deformity Cause in the literature Typical correction
polly-beak supratip fullness above a drooping tip under-resected cartilaginous dorsum / dead space scar / loss of tip support supratip reduction, tip support (strut/SEG), steroid injection early
inverted-v visible ULC–bone step on frontal view midvault collapse after hump removal without spreader grafts (Rohrich 2004) spreader grafts / spreader flaps (Sheen 1984)
open-roof flat wide dorsum after hump removal no osteotomies to close the roof lateral osteotomies, onlay
saddle-nose dorsal collapse over-resected septum / L-strut failure / cocaine, trauma rib dorsal graft, L-strut reconstruction (Cochran & Gunter 2010)
pinched-tip alar collapse, bossae over-resected lateral crura lateral crural strut grafts, alar rim grafts (67% in Guyuron series)
alar-retraction notched nostril rim over-resection / scar contracture rim grafts, composite grafts
airway-obstruction valve collapse, septal deviation midvault narrowing, untreated septum (65% of revision complaints) spreader grafts, septoplasty (71%), valve repair

Surgeons on the site who publish on this

Guyuron (#4), Toriumi (#7, discussant), Cochran (#19), Gunter and Sheen (history), Saban (world).

Gaps

  • A published overall revision rate for primary rhinoplasty (search: "revision rate" rhinoplasty systematic review).
  • Polly-beak and alar retraction primary references (Rohrich; Toriumi; Guyuron).

Sources