Rhinoplasty is one of the most difficult operations of facial plastic surgery. Since the nose is located exactly in the middle of the face, its irregular shape causes both aesthetic and functional problems.

Rhinoplasty began as a reconstructive procedure and since the late 1800s has evolved as a size reduction operation. American otolaryngologist Joseph Roe is known for the first intranasal (closed rhinoplasty) approach in rhinoplasty in 1887.

Reshaping of the tip of the nose began with scoring, resection and transection. As the number of rhinoplasty surgeries has increased, secondary deformations – problems of nose aesthetics have appeared. After rhinoplasty operations, even the most experienced surgeons may require revision rhinoplasty (secondary rhinoplasty) in 3-15% of cases.
In the 1970s and 1980s, new rhinoplasty techniques were developed for operations for secondary deformities.

Jack Sheen made the greatest contribution to the development of dorsal grafts, tip grafts, expansion grafts and other techniques for reducing noses more than the norm.

The most common problems and diagnoses among patients visiting revision rhinoplasty surgeons are:
Pinching and hanging columella, “saddle nose” deformity, scar tissue, asymmetric dorsum resection, “open roof” deformity, increased and decreased tip projection, bullous or broad tip, tip asymmetry, “Bossae”, “Pollybeak”, external and internal valve collapse, asymmetries in the nostrils, etc.

Psychological evaluation, anatomical evaluation, facial analysis, physical examination and photographic analysis should be performed in patients interested in secondary rhinoplasty.

The most commonly used approach in revision rhinoplasty is open rhinoplasty using cartilage taken from the rib. If you ask when to do secondary (tertiary) operations on the nose, then I note that for minor deformities it is recommended to carry out 3-6 months after the last operation, and for large deformities and revision rhinoplasty in general it is recommended to carry out at least 1 year after the last operation.

To ensure that the blood supply is not disrupted even more during the elevation of the skin and soft tissues, it should be performed very close to the cartilage, anticipating grafts or irregularities placed during the previous operation
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In revision rhinoplasty, autogenous cartilage and grafts taken from 6-7 ribs are used by the oblique dissection method of Eren Tastan. If an alloplastic material is needed, sometimes it can also be used.
In the case of a combination of excessively thin skin and developed cartilage, a good result is achieved by thickening with the help of subcutaneous fascia, cartilage, or grafts of crushed cartilage. Crooked noses that cannot be completely corrected surgically can be camouflaged with spreaders or external lateral nasal wall grafts. In thick-skinned cases, there is a greater need for cartilage support during surgery.

Alloplastic implants for thickening, supporting or contouring the tip of the nose are contraindicated.

We can straighten the bone without damaging the soft tissues by inserting a strong rasp through a limited and small incision. The collapse of the middle belt (inverted V-shaped deformation) is corrected by bilateral placement of expansion grafts through two incisions or open access.
If there is cephalic alar traction, a composite ear graft should be used for treatment.
In case of revision rhinoplasty, it is best to decide on a closed rhinoplasty with a limited incision of the nose and minimal damage to the surrounding tissues or open rhinoplasty due to the need for reconstruction. Piezo-Rhinoplasty – Ultrasound rhinoplasty technique is also an excellent way for revision rhinoplasty and septorinoplasty surgeries.