What is Secondary Rhinoplasty?

Secondary rhinoplasty is the procedure performed for the second, third, fourth, or fifth time and is perhaps the most challenging of all facial surgery procedures. Its actual name is “revision rhinoplasty.” Even in the best hands, external deformities or breathing difficulties can occur after rhinoplasty. This is due to the complex anatomy of the nose and the individual patient’s internal healing factors, which can be “erratic,” meaning they cannot be controlled by the surgeon or the patient.
Scar tissue from a previous rhinoplasty is often a problem in revision cases and can limit the final result. Additionally, revision rhinoplasty often requires the use of cartilage to replace damaged and/or deficient cartilage extracted in the previous surgery, as well as to provide support to the new structure.

The nasal septum may be deviated, requiring correction to improve both the appearance and function of the nose. Nasal obstruction can also be caused by collapse of the tip cartilages, leading to collapse of the external valve. Deviated nasal septum along with deficiencies in the upper lateral cartilages are a common occurrence in revision cases resulting in collapse of the internal valve, which requires the use of cartilage grafts called “spreader grafts” to open up this narrowed area.

The Importance of Surgeon’s Experience in Secondary Rhinoplasty

In such cases, when a second surgical procedure is performed, the surgeon’s experience becomes even more important. Dr. Susan Diaz Reverand, as a Specialist in Maxillofacial Head and Neck Surgery, specialized in racial and nasal reconstructive surgery, has developed an important regional referral practice for revision rhinoplasty in Barcelona and beyond.

The recovery from secondary rhinoplasty is quick. The word “ultrasonic” added to the term “revision rhinoplasty” means that the surgeon will not only perform the relevant nasal reconstructions but will also incorporate complex reconstructive techniques using the new technologies of the 21st century. In this case, it is the utilization of ultrasound or piezoelectricity in nasal reconstruction, which is a device that allows precise filing of irregularities and also provides a simpler postoperative period, rapid recovery, with less swelling and/or bruising compared to the traditional method.

If you have undergone rhinoplasty and are experiencing breathing problems or the external shape of your nose is not correct, a consultation with Dr. Diaz can help determine if you are a candidate for this procedure.


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Secondary Rhinoplasty Before and After:

mujer tumbada despues de cirugía estetica de nariz
Here we see the results of some surgeries performed by Dr. Susan Diaz Reverans in Caracas, Venezuela, and Barcelona, Spain. We can clearly see the drooping of the nose after a rhinoplasty. Then, we observe how the doctor achieves firmness and an uplift of the nose that few surgeons can achieve.
Hombre rinoplastia de revisión en carcas

Am I a good candidate for secondary rhinoplasty surgery?

The best candidates for ultrasonic secondary rhinoplasty or revision rhinoplasty are individuals who are both emotionally and physically healthy, as well as realistic about the potential for improvement. A person with a secondary nasal problem should seek improvement, not perfection. Dr. Diaz prefers to carefully evaluate patients with a secondary nasal problem to assess their deformity and ensure that the patient is realistic about the potential revision. Depending on the type of deformity, the nasal shape or function may or may not be fully improved. Deciding to undergo secondary nasal surgery should not be an impulsive decision but rather a carefully considered one. That is why it is important to be realistic, well-informed, and true to yourself about what truly bothers you about your results.

What should I expect from my consultation?

During your consultation for ultrasonic secondary rhinoplasty, Dr. Diaz will ask you how you would like your nose to improve. She will examine the internal and external structure of your nose and discuss possibilities with you. She will also explain the factors that may influence the procedure and the results. These factors include the remaining structure of the nasal bones and cartilage, facial shape, skin thickness, age, and expectations.

You will learn about secondary nasal surgery, its limitations and risks, and discuss your needs and concerns. This will help Dr. Diaz better understand your expectations and determine if they can be realistically achieved. After your consultation, photographs will be taken for your medical records, and subsequently, you will receive a personalized surgery cost estimate. A follow-up appointment will be scheduled to review the images and finalize details.

How is secondary rhinoplasty surgery performed?

Surgery for secondary nasal deformity is referred to as an “open approach” rhinoplasty. The open approach, which is preferred by Dr. Diaz, involves separating the skin of the nose from its underlying bone and cartilage support structure. This approach allows Dr. Diaz to see the entire structure of the nose. She will then reshape the nose to the desired form. The nature of the sculpting will depend on the nature of your problem and Dr. Diaz’s preferred technique. There are countless techniques that can be used to sculpt the underlying framework when it comes to secondary nasal revision. Dr. Diaz prefers to use the patient’s own tissue (such as cartilage from the septum, ear, or rib).

When the surgery is completed, a splint is applied to help the nose maintain its new shape. Soft plastic splints may also be placed in the nasal passages to stabilize the septum and divide the airway to improve nasal breathing.

The procedure

The procedure is usually performed under general anesthesia. The incisions are mainly internal, although a small external incision is sometimes used. The bone and cartilage of the nose are reshaped using ultrasound or piezoelectric instruments, and care is taken to preserve nasal breathing function. Dr. Diaz can often improve the nasal breathing of her patients.

Ultrasound revision rhinoplasty applies to any patient who has previously undergone one or more rhinoplasties and wishes to improve the appearance and often the function of the nose. These are among the most challenging cases that aesthetic plastic surgeons face for several reasons.

Ultrasound revision rhinoplasty often requires cartilage as structural support for the tip and/or bridge of the nose. Septal cartilage is often deficient, and surgeons often have to choose cartilage from other parts of the body, particularly the ear and occasionally the rib. Soft tissue irregularities along the nasal bridge or tip may also require tissue that provides cover or camouflage and acts as a permanent “natural filler.” An excellent source is “temporal fascia,” which can be taken from a remote incision within the hairline and does not produce a noticeable deficit. Occasionally, scarring within the nose requires the use of skin grafts to reopen distorted and narrowed nasal airways.


“Dr. Diaz is an excellent professional, not only for the nose surgery she performed on me, which turned out very well, but also for how attentive, patient, and approachable she is. She has excellent communication skills, listens to you, understands your needs and wants. After the surgery, she was very attentive to ensure everything was going well. In short, she is a great professional.”
“My visit with Dr. Susan Diaz was very professional and relaxed. She took the time to clarify all my doubts and offered possible alternatives to improve my nose. I left the consultation extremely happy and with a beautiful nose that will last me a year.”