Revision Rhinoplasty

Revision rhinoplasty: how to face a disappointing nose job

What to do if the result of a primary rhinoplasty does not live up to your expectations? How to solve physical or functional defects that appear after surgery? One solution may be revision rhinoplasty, which is a second nose job to correct unsatisfactory surgical outcomes. Nose revision surgery can correct both aesthetic imperfections and alterations in respiratory function. For instance, the revision rhinoplasty expert can give a more natural appearance to the so-called surgical nose.

The lack/inadequacy of structural support contributes to the difficulty of revisions in what may become extreme rhinoplasty. Until a few decades ago, excessive cartilage removals were almost the rule. Fortunately, however, minimally invasive techniques have made structural grafts superfluous in most primary rhinoseptoplasty. So, in recent years, this problem has become less and less frequent.

What some may present as a simple “nose job” is a full-fledged surgery. Each male or female rhinoplasty has its inherent complexities and requires precautions and prudence. The experienced surgeon knows that there is the possibility of having to intervene a second time on the same patient: it is a statistical fact. Therefore, a surgical revision specialist will adopt a cautious and conservative attitude already in primary surgery, preparing for the possibility of a nose job revision.

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The best nose job revisions: from adjustments under local anesthesia to extreme surgery

Let’s take it for granted that there is no “routine” surgery. However, we can distinguish nose jobs revisions for their technical complexity. Of course, we cannot equate extreme rhinoplasties and touch-ups under local anesthesia. But both situations require all the attention and experience of the surgeon.

The secondary rhinoplasty specialist must know how to evaluate and deal with the specific complexities that characterize each rhino-septoplasty. The revision expert can address complex problems such as:

  • the saddle nose, or the indentation of the nasal spine, caused by excessive removal of the bone or cartilage support;
  • an unnatural profile with notches on the nasal dorsum or sides, due to insufficient or inadequate osteotomies;
  • the inverted-V deformity, a disarticulation between bone and cartilage due to aggressive surgical maneuvers.

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The best second rhinoplasties depend on the right approach in the first

When the first surgeon uses minimally invasive techniques and a conservative attitude, the final result is generally more predictable. Consequently, possible revisions are easier to manage, offering more room for maneuver and safety.

Sometimes, however, due to inexperience or overconfidence, the surgeon:

  • accepts incongruous, unrealistic, or risky requests such as the claim of a specific profile unsuitable for the existing anatomical structure;
  • neglects the importance of a thorough and accurate preoperative analysis;
  • uses cartilaginous grafts even when not strictly necessary (i.e., when the osteocartilaginous skeleton has an evident support defect);
  • ransacks the nasal structures, opening the way to defects emerging in the long term.

In all these cases, the patient may need a revision rhinoplasty expert to correct cosmetic defects such as a surgical nose, the collapse of the nostrils or dorsal structure, discrepancies or asymmetries, and even major functional problems.

Nose job revisions for defects related to the healing process

A complex art such as nasal surgery requires a long and in-depth experience. However, even the most experienced and competent surgeons can run into the dissatisfaction of some patients or disappointing results. The healing process is an unpredictable variable that can affect the outcome of surgical procedures.

Atypical scar evolutions, linked to the healing process, are more frequent after open rhinoplasty with significant dissections. The most common are Polly tips, fibrous thickenings of the nasal tip that we can treat with infiltrations of steroids. More than a surgical procedure, the treatment of these tenacious fibrous swellings is part of the outpatient touch-ups.

The correction of minor imperfections of the back or tip (projection-rotation) under local anesthesia is also minimally invasive. However, the best secondary rhinoplasty always starts with a thorough post-operative check-up and a correct diagnosis.

Revision rhinoplasty specialist in Milan

What to do if you are not satisfied with your appearance after the first rhinoseptoplasty? You can go back to the same surgeon who operated on you in the first place and demand a nose job revision. Or, especially when the problems arise from inexperienced or reckless surgical choices and maneuvers, you can contact an expert in revision rhinoplasties. Rhino and septoplasty do require a considerable amount of experience, competence, and skill.

In the case of revision rhinoplasties, the surgeon must possess even more sophisticated skills, from preoperative analysis to precision of maneuvers. Each secondary or tertiary rhinoseptoplasty is a unique and complex operation. Only the most experienced surgeons can deal with the so-called cases of extreme rhinoplasty, which require attention, versatility, and finesse.

Before surgery, each patient must carefully choose which specialist to entrust the appearance of their nose. Even more attention, scruple, and caution are required to find the specialist to correct a disappointing nose job.

Pietro Palma is now considered the best surgeon for secondary rhinoplasty in Milan. In over twenty years of specialized surgical practice, Pietro Palma and his team have faced a wide range of aesthetic and functional problems of varying complexity.

Frequently, the revision surgeon has to perform reconstructions of great technical complexity that configure situations of extreme nasal surgery. Severe structural alterations of the bone and external and internal cartilage skeleton require the use of heterologous cartilage taken from the ribs or the ear (ear cartilage rhinoplasty).

If you want more information on secondary/tertiary rhinoplasties or find out if you are an ideal candidate for a revision procedure, make an appointment with your surgeon for a no-obligation evaluation.

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Pietro PALMA Chirurgo Rinoplastica



The aim of the first consultation is to make a correct diagnosis of your external and internal nose as well as to evaluate your past medical history. Specific nose-related symptoms will be evaluated by taking a thorough history, a nasendoscopy, and performing morphological analysis of the external nose. Finally, I will take professional quality photographs of your face and nose for detailed analysis.


The first consultation is not aimed to sell a product. It cannot be free of charge as it is a very specialized consultation lasting 30’-45’ by an international rhinoplasty expert using high tech-tools in a modern, comfortable and well equipped medical office.


As each case is different, a standard cost cannot apply. Costs are related to the extent of surgery and the duration of the operation. Within the first 48-72 hours of the first consultation, a detailed quotation will be emailed to you.


As your surgeon, I will adapt my technique to match your specific anatomical findings and with respect to your wish list of desirable changes. Due to my decades of dedicated rhinoplasty surgery, I can call upon a vast array of techniques in order to safely cope with the myriad variants of nasal anatomy.

I prefer closed (endonasal) rhinoplasty for most of my patients in order to be respectful of nasal anatomy and avoid unnecessary surgical aggressiveness. In more complex cases, I use an “hybrid” closed approach that allows me to utilize techniques commonly used in the open approach (sutures, grafts) but without opening the nose. I opt for the open approach in severe malformations or in specific revision cases.


The nose is a complex structure in which form and function are intimately connected. Almost always, rhinoplasty is a septo-rhinoplasty because the septum not only plays a functional role, but also contributes to common problems of the external nose. Examples include: crooked nose, hump, drooping tip, excessive nasal length, over-projection of the nasal tip, just to name a few of the common deformities seen in my practice.

Inferior turbinates are probably the commonest cause of nasal obstruction, and their treatment is commonly associated with septo-rhinoplasty or rhinoplasty. Modern, minimally invasive endoscopic techniques allow the surgeon to manage these important structures precisely and conservatively.
Therefore, it is absolutely indispensable that your rhinoplasty surgeon possesses specialist training and substantial experience in treating problems of the internal nose.

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