Revision rhinoplasty in Turkey: without rushing into a second operation.

Revision rhinoplasty is a corrective operation to treat a remaining shape deformity or breathing problem in people who have had one or more nose operations. It is also known as secondary rhinoplasty. For some patients it means a brief rasping; for others, rebuilding the cartilage framework from scratch.

Our rhinoplasty guide includes a short section on this topic. Here we go into more depth, because the decision on a second operation raises different questions from the first operation: How long should I wait? Is there enough cartilage left in my nose? What can a second operation correct, and what can it not?

• Corrects shape problems left by the first operation
• Uses grafts to support areas that collapsed after too much tissue was removed
• Relieves breathing obstruction that developed after surgery
• Balances a nasal tip and nostril wings that healed asymmetrically

Most requests for revision rhinoplasty concern appearance; however, breathing complaints account for a significant share, and the two often occur together.

• Residual hump: bone or cartilage not sufficiently removed from the bridge of the nose
• Pollybeak deformity: fullness just above the nasal tip, making the tip look droopy
• Saddle nose: a dip caused by removing too much of the bridge
• Inverted V deformity: the edges of the nasal bones becoming visible as the middle vault collapses
• Nasal tip problems: a tip that is over-rotated, droopy, poorly defined or asymmetric
• Alar retraction: too much of the nostrils showing from the side
• Functional problems: nasal valve collapse, septal deviation, adhesions inside the nose

That is why a revision plan starts not with “I don’t like my nose” but with problems named one by one.

Because the true result of the first operation only becomes clear after a year. Scar tissue can take up to a year to mature; a revision before then means operating on tissue that is still changing. A review in Seminars in Plastic Surgery also recommends waiting at least a year in most cases.

The same review allows one exception: limited corrections, such as a small residual hump or repositioning the bones, can be done earlier. Procedures that require extensive opening of the soft tissue are left until a full year has passed.

• Swelling at the nasal tip is the last to settle; it takes longer in patients with thick skin
• Some of the asymmetry seen in the first months comes from swelling going down unevenly
• Operating before the tissue has softened increases the likelihood of bleeding and new scarring

Revision rhinoplasty is considered one of the most difficult operations in plastic surgery, because the surgeon works not with untouched anatomy but with tissue already altered by another surgeon, or by themselves. The difficulty comes from four sources.

• Scar tissue: the layers have stuck together; separating the skin from the framework takes longer and carries more risk
• Reduced cartilage: the septum, the most suitable graft source, has often been used in the first operation
• Skin envelope: thick skin hides fine detailing; thin skin shows the smallest irregularity
• Unpredictability: what remains inside only becomes clear during surgery; the surgeon must have a back-up graft plan ready

For this reason, the revision usually takes longer than the first operation and is mostly performed with the open technique.

In revision rhinoplasty, the graft is chosen according to need: ear cartilage is enough for a small filling or nostril support, while rib cartilage is used when strong support is needed to carry the framework of the nose. If enough cartilage remains in the septum, it is still the first choice. The American Society of Plastic Surgeons gives the same order: most often septum, sometimes ear, rarely rib.

The known weakness of rib cartilage is that it can warp over time, and surgeons try to reduce this through their carving technique. Before a revision that requires grafts, always ask which source is being considered and whether there will be a second incision site.

No. Revision rhinoplasty is the nose operation with the widest range in scope: at one end is a limited touch-up, at the other a reconstruction of the nose. Where you fall is determined not by how big your complaint is, but by the underlying structural deficit.

• Limited correction: rasping a small residual hump, correcting a single irregularity
• Moderate scope: reshaping the nasal tip, support with a graft taken from the septum or ear
• Reconstruction: rebuilding a collapsed bridge and a weakened framework with rib cartilage

For very small dents, some doctors suggest filler as a temporary option. Filler is not permanent, and it does not solve a structural problem that needs revision surgery.

What you should expect is a clear improvement in a named problem; what you should not expect is a nose that looks as if it had never been operated on. The result of revision rhinoplasty is limited as much by the quality of the remaining tissue as by the surgeon's skill. If the skin has lost its elasticity or the cartilage framework is very weak, what can be achieved narrows too.

• Rank the problems to be corrected by importance; the first two items are often the real goal of the operation
• Millimetre-level asymmetries exist in every face and cannot be fully removed with surgery
• When breathing and appearance conflict, breathing takes priority
• A small correction may still be needed after the second operation

1. Gathering your documents. You will be asked for the report from your first operation (discharge summary), before and after photos and any CT scans. If you do not have a report, say so from the start.
2. Remote preliminary review. Your current photos and list of concerns are reviewed; an initial assessment is shared on whether enough time has passed for a revision and whether a graft will be needed.
3. Examination. The surgeon assesses the inside and outside of the nose, checks the cartilage remaining in the septum and looks at skin thickness.
4. Surgery. Revision rhinoplasty is performed under general anaesthesia. If a graft is needed, it is taken from the ear or rib in the same session.
5. Observation and splint. A splint is placed on the outside of the nose and, if needed, silicone supports inside. You can find an overview of the whole journey on our treatment process page.
6. Long-term follow-up. Check-ups continue with photos; the final assessment is made at the twelfth month at the earliest.

After revision rhinoplasty, getting back to daily life takes a week or two, much as after the first operation, but swelling settles more slowly. The American Society of Plastic Surgeons notes that cartilage grafts and extensive tissue dissection prolong healing. The timings below are based on Cleveland Clinic's rhinoplasty information as a general framework.

If rib or ear cartilage was taken, expect a separate incision and dressing in that area too, with some extra pain in the first few days. The NHS nose reshaping (rhinoplasty) page recommends waiting 4–6 weeks before strenuous exercise and contact sports.

For revision rhinoplasty, the programme is usually based on 7–10 days, and the check-up at which the splint is removed takes place before you leave the country. The difference from the first operation lies in the preparation: the report from your previous operation needs to reach the surgeon before your travel dates are set.

• If you had your first operation in another country, send the report together with a translation
• If rib cartilage was used, the chest incision is also checked before you travel home; avoid lifting luggage on the journey
• The surgeon gives clearance to fly at the check-up examination
• Accommodation and transfers are arranged close to the hospital

Neda Deniz holds the Turkish Ministry of Health International Health Tourism Authorisation Certificate (AK-1032) and is an intermediary agency, not a clinic. All operations, including revision rhinoplasty, are performed by our partner specialist surgeons in the relevant hospitals. The surgeon we work with in nasal surgery is the Ear, Nose and Throat and Head and Neck Surgery specialist Prof. Dr. Kürşat Yelken. Which surgeon you proceed with becomes clear after the preliminary assessment. At the consultation, ask how many secondary rhinoplasties the surgeon performs each year, which graft source they choose and why, and what might not be corrected.

Under Turkish regulations, prices for healthcare services may not be advertised. A revision is also the nose operation whose scope varies the most, so figures given without an examination are not reliable. In the UK, the NHS rarely funds cosmetic revision surgery; functional (breathing) problems are assessed separately. The cost is made up of the following:

• Scope: the difference between a limited correction and a reconstruction
• Graft source: harvesting ear or rib cartilage lengthens the operation
• Functional repair: additional procedures on the septum and nasal valve
• Tests: CT scan and blood tests
• Hospital, anaesthesia, accommodation and follow-up

For a first nose operation, our rhinoplasty page sets out what the package includes.

Revision rhinoplasty carries all the risks of the first operation, plus those arising from grafts and scar tissue. In Turkey, practice follows the guidelines of the Turkish Society of Plastic, Reconstructive and Aesthetic Surgeons and the relevant specialist societies.

• Persistent breathing difficulty or a change in your sense of smell
• Septal perforation and recurrent nosebleeds
• Skin discolouration and poor wound healing
• Warping or shifting of the graft
• Donor site problems: an additional incision, pain and a scar on the chest or ear
• Prolonged swelling and stiffness
• Unsatisfactory result: the need for a further correction
• Bleeding, infection and anaesthetic complications

Smoking impairs wound healing; you should stop before the operation for the period your surgeon specifies.

If you are also researching topics other than revision rhinoplasty, these guides may be useful:

• Rhinoplasty guide — open and closed techniques, septorhinoplasty
• Double chin surgery guide — choosing the method by fat, muscle and skin
• Facelift guide — four techniques and recovery
• Voice feminisation surgery guide — techniques and voice therapy

Before deciding on revision rhinoplasty, answer three questions: Has a year passed since the first operation? Can I name what bothers me in one sentence? Do I accept that a small imperfection may remain even after a second operation? If you can say yes to all three, it is the right time for an assessment.

Send us your operation report and your old and recent photos for our partner surgeons to review. We will tell you clearly what revision rhinoplasty can improve, whether a graft will be needed and whether it would be better to wait.