Secondary Rhinoplasty

When the first nose surgery is not entirely satisfactory, the patient may request a secondary rhinoplasty. The goal is the correction of aesthetic or functional defects of varying degrees that may depend on the surgical maneuvers or the healing process. Several individual factors can alter the healing process. Among them:

  • peculiarities of the osteogenesis process;
  • a thick skin;
  • a tendency to subcutaneous fibrosis.

Even when the surgeon works with experience and care, minor asymmetries or irregularities of the dorsum, nostrils or tip can occur. Patients wishing to adjust the appearance of their nose after surgery can return to the same specialist or go to a surgeon who specializes in secondary and tertiary rhinoplasty.

Sometimes, small outpatient refinements or minor adjustments under local anesthesia are sufficient. At other times, the individual nasal components need to be revised, such as in secondary nasal tip surgery. Finally, in the most critical cases, it is necessary to face reconstructions of considerable technical complexity that may require the use of cartilage taken from the ear or the ribs (ear cartilage rhinoplasty).

Only the best secondary surgeons can perform this type of complex surgery. The second rhinoplasty requires considerable surgical maturity, technical skills, versatility, and readiness in the face of the unexpected.

Contact us for more information on secondary rhinoseptoplasty in Milan and arrange an interview with the specialist currently considered the best surgeon in Europe for nose revisions. If you want to find out how other people have improved their appearance with a second nose job, check out the gallery dedicated to cases of the second rhinoplasty before and after.

Second rhinoplasty before and after

My Patients’ Journey with Me

Secondary rhinoplasty: frequent causes and surgical corrections

As male and female rhinoplasties become more and more common, requests for revision are also increasing in parallel. The so-called secondary rhinoplasty aims to correct any post-surgical imperfections. The unsatisfactory outcome may depend on the surgical maneuvers of primary rhinoplasty or on unexpected events related to the healing process. When to contact the specialist for 2nd or 3rd rhinoplasty? In general, the patient is not satisfied with the first nose job. The procedures and intensity of the intervention may vary.

When to contact the specialist for 2nd or 3rd rhinoplasty? In general, whenever the patient is not satisfied with the first nose job(s). The modalities and intensity of the intervention may vary.

  • In simple cases, the revision surgeon can make minimal corrections on an outpatient basis under anesthesia.
  • When functional or cosmetic defects are relevant, it may be necessary to perform a proper second rhinoplasty.

Surgical revision can address particularly pernicious problems, including:

  • depression of the central part of the nasal dorsum (so-called saddle nose or ENT nose – otolaryngology) due to excessive surgical removal;
  • irregular or asymmetrical tip due to excessive resection of the cartilage;
  • saddle nose or indefinite nasofrontal profile/angle due to excessive or insufficient removal of the nasal bones;
  • lateral notches post-hump resection due to incorrect positioning of the nasal bones.

Abnormal scar growth can cause thickening of the tissues. To address problems such as fibrous or inflammatory Polly tip, we can use steroid infiltrations.

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What defects can we correct with a second nose job

The patient may be disappointed with the aesthetic or functional outcomes of his/her nose job. Surgical revision allows us to fix various problems: let’s see them briefly.

Post-surgical deviated septum

Nasal septal deviations have several causes attributable to cartilage or bone. First, we must ascertain the origin of the defect: was it pre-existing and not properly addressed? Or was it caused by surgery? Before operating, we must perform a careful diagnosis with a thorough radiographic investigation.

Revision of post-surgical deformity of the dorsum

Inverted V deformity is an alteration in the width of the nasal dorsum due to excessive or reckless removal of the triangular cartilages in the first operation. In these cases, it is common to resort to cartilage grafts taken from the ear with the spreader graft technique.

Nasal tip improvements

To give support and projection to a collapsed nasal tip, we can use a columellar strut. We take a small portion of cartilage from the septum and insert it at the level of the columella. To correct an irregular, bulbous or globose nasal tip, we can perform sutures between the cartilages.

Nose job revision under local anesthesia

Before and after the second rhinoplasty, we can see many differences, not always pleasant. Sometimes, minimally invasive procedures may suffice to resolve post-surgical dissatisfaction. We try to spare the patient from anesthesia and post-operative night hospitalization whenever possible.

Today, we have more precise and less invasive surgical techniques that allow us, in some cases, to operate under local anesthesia with conscious sedation. Such is the case, for example, of minimal irregularities of the nasal dorsum or tip. Secondary nose jobs under local anesthesia have several advantages:

  • they do not need intubation;
  • do not involve the use of tampons;
  • they do not cause bleeding;
  • provide for same-day discharges, according to the modalities of the outpatient day hospital;
  • require shorter recovery times, causing reduced discomfort.

However, the extent and type of defect are not always compatible with day-hospital treatment. Sometimes, only actual surgery allows us to address the critical issues detected. For a professional evaluation of your post-surgical defects, contact us and make an appointment with the best secondary/tertiary rhinoplasty surgeon in Milan.

Your surgeon for the secondary rhinoplasty in Milan

Contact us for a preliminary consultation concerning a secondary rhinoseptoplasty in Milan. Keep in mind that revisions are always more complex than primary rhinoplasties, especially when the septal cartilage is absent/insufficient. Removing disproportionate amounts of cartilage in the first surgery can cause a lack of structural support in the dorsum or tip. Consequently, the maneuvers of the second nose job require even more skill, precision, and competence.

As we have seen, in simple cases, we can retouch the tip or the dorsum under local anesthesia. In more complex cases, however, a proper secondary surgery is required. While it would be unreasonable to underestimate the challenge of primary rhinoplasty, a second or third surgery requires even more maturity, experience, and skills. The best secondary rhinoseptoplasty surgeon knows how to deal with high technical complexity and long working times. The surgical revision expert is ready to face unexpected events and side effects in cartilage harvesting areas.

Contact us if you want more information on secondary rhinoplasty: you can arrange a preliminary interview with the best secondary rhinoplasty surgeon in Milan.

Connect with us

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.

Follow us on Instagram and stay tuned!

I am happy to attend the Annual Meeting of the European Academy of Facial Plastic Surgery (EAFPS) to be held in Verona, September 14-17.🇮🇹
Every year a WORLD-RENOWNED surgeon and MENTOR is appointed to deliver the Joseph Lecture at the EAFPS Annual Meeting, in honour of Jacques Joseph (1865-1934), the father of rhinoplasty.

This year I have the HONOR and the PRIVELEGE to be the Joseph lecturer.

It happens ONCE in a life time.

🔷 I will share my experience as well as the ideas that I have developed in my LONG RHINOPLASTY JOURNEY shared with thousands of patients.
- visual distractors,
- hybrid route,
- multiportal approach,
- aesthetic subunits of the nose,
- analytical/surgical focus on nasal surface and contours will be explained in details.
🔷 I aim to the NEXT LEVEL of results while REDUCING surgical invasiveness.

🔹 I thank my PATIENTS wholeheartedly for their trust.
🔹 I thank my MENTOR Prof. Giorgio Sulsenti.
🔹 I thank my dearest FRIEND , Prof. Paolo Castelnuovo.
🔹 I thank the many COLLEAGUES that have been teachers and role models.
🔹 I thank my FAMILY for giving me strength and love to pursue such a passionating professional path.

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🎤I'm a SPEAKER at the 46th annual meeting of the EAFPS (European Academy of Facial Plastic Surgery) in Verona.
The meeting is just around the corner.
📌Mark your agenda and JOIN US for the ONLY ONE and UNIQUE session of this meeting where we'll talk about PROFESSIONAL but NOT TECHNICAL aspects that are essential for each of us.
Are you curious?
➡️Follow me and in the coming days I'll reveal a secret.
Beautiful and romantic Verona, where surgery meets beauty, is waiting for us!

#eafps #eafps2023 #eafpsannualmeeting #womeninsurgery #YOUniqueRhinoplasty #verona

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