Revision Rhinoplasty London

Primary rhinoplasty can produce an unsatisfactory result for many reasons, and understanding the cause is essential to planning the correction:

Over-resection: Too much cartilage or bone was removed. This is the most common cause of problems I see. An over-reduced bridge creates a scooped profile. An over-narrowed tip loses projection and can collapse. Over-aggressive osteotomies produce a pinched, unnatural look.

Functional compromise: The airway was damaged during cosmetic surgery. This includes nasal valve collapse (where the sidewalls of the nose cave inward when you breathe in), septal perforation, or turbinate over-reduction leading to paradoxical obstruction (empty nose syndrome).

Asymmetry and irregularities: Uneven healing, graft displacement, or asymmetric bone work can produce a crooked result or visible irregularities.

Inadequate change: Sometimes a conservative primary rhinoplasty simply didn't achieve enough change. This is usually the most straightforward revision.

Pollybeak deformity: A full appearance above the tip, caused by scar tissue accumulation or inadequate reduction of the cartilaginous dorsum relative to the bony dorsum.

Every revision begins with understanding what happened the first time. I ask patients to bring any operative notes or correspondence from their primary surgeon. I then conduct a thorough external and internal examination, including endoscopy of the nasal cavity and a PNIF (peak nasal inspiratory flow) test to objectively measure your breathing.

Revision rhinoplasty almost always requires grafting. Because cartilage was likely removed during your primary surgery, I often need to harvest additional cartilage — from your ear (conchal cartilage) or, in more complex cases, from your rib (costal cartilage). This grafting material is used to rebuild structure, restore support, and create definition that was lost.

I typically perform revision rhinoplasty via an open approach, which gives full visibility of the altered anatomy and allows precise placement of grafts. The external scar (at the columella, between your nostrils) heals to become virtually invisible.

Timing matters: I generally ask revision patients to wait at least 12 months — and ideally 18 months — after their primary surgery before proceeding with revision. This allows swelling to fully resolve, scar tissue to mature, and the nose to settle into its final shape. Operating too early risks working on tissue that is still changing.

Revision rhinoplasty is not simply “doing the same thing again.” It's a fundamentally different operation:

Scar tissue: Previous surgery creates internal scar tissue that distorts the surgical planes. The dissection is more difficult and the tissue is less predictable.

Reduced cartilage: Your primary surgeon likely removed cartilage. There's less raw material to work with, which is why grafting from the ear or rib is often necessary.

Compromised blood supply: Prior surgery disrupts the blood supply to the nasal skin. This means healing is slower and the risk of skin complications is higher.

Higher stakes: Patients undergoing revision have already invested time, money, and emotional energy in a result that didn't meet expectations. Managing expectations for the revision is critical — and I'm always honest about what's achievable.

Because of these factors, revision rhinoplasty typically takes longer in the operating theatre (2–3 hours versus 1.5–2 hours for primary), and the recovery is somewhat longer, with more swelling in the first few weeks.