Secondary Rhinoplasty in Londrina: specialized correction for unsatisfactory results
If you are reading this page, you have probably undergone a rhinoplasty that did not deliver the result you expected. Perhaps your nose ended up crooked, the tip dropped over time, irregularities appeared on the dorsum, or you simply cannot breathe properly. I want you to know one thing: you are not alone. International studies show that between five and fifteen percent of primary rhinoplasties require revision. And correcting a previously operated nose is precisely one of the areas in which I specialize the most.
Secondary rhinoplasty — also called revision rhinoplasty — is the surgery aimed at correcting aesthetic or functional problems resulting from a previous rhinoplasty. It is a considerably more complex procedure than primary rhinoplasty because the surgeon has to deal with scar tissue, distorted anatomy, and often a lack of cartilage. It requires a deep understanding of nasal anatomy, mastery of grafting techniques, and a lot of surgical experience.
Over more than twenty years of practice and more than eight thousand surgeries performed, I have developed a structured approach to secondary rhinoplasty that allows me to reconstruct noses severely compromised by poorly executed previous surgeries. I receive patients from all over Paraná, São Paulo, Minas Gerais, and other states in Brazil who specifically seek me out for this correction. It is a privilege and a responsibility that I take very seriously.
Subscribe to my YouTube channel:
Why secondary rhinoplasty is more complex than primary rhinoplasty
Many patients ask me: "Doctor, if I have already had surgery once, shouldn't the second be simpler?". The answer is exactly the opposite. Revision rhinoplasty is considered one of the most challenging procedures in all of facial plastic surgery. And the reasons are many.
Scar tissue: the invisible enemy
Every surgery generates internal scar tissue. In secondary rhinoplasty, the surgeon needs to dissect through layers of fibrosis that distort the normal anatomical planes. Scar tissue is stiffer, bleeds more easily, and obscures the structures that need to be identified and worked on. It's like renovating a house that has already been renovated several times: the walls are no longer where they should be, the pipes have been diverted, and there are surprises around every corner.
Lack of cartilage: the structural challenge
In primary rhinoplasty, the surgeon often removes cartilage to thin or reduce the nose. In revision, that removed cartilage is missed. Without enough structural material, the nose loses support, the tip droops, the side walls collapse, and breathing becomes compromised. This is why most secondary rhinoplasties require cartilage grafts from donor areas such as the ear or rib.
Distorted anatomy
The previously operated nose no longer has its original anatomy. Cartilages have been cut, displaced, or removed. Bones have been fractured and repositioned. Ligaments have been torn. The revision surgeon needs to understand exactly what was done in the first surgery to plan the reconstruction. It's like putting together a puzzle where some pieces are missing and others have been forced into the wrong place.
Compromised skin
The skin of the previously operated nose may be thinner, adhered to the cartilaginous skeleton, or, conversely, thickened by fibrosis. Each scenario requires a different strategy. Very thin skin will show any minimal irregularity of the grafts. Very thick skin will mask delicate refinements and limit the outcome.
When secondary rhinoplasty is indicated
I recommend revision rhinoplasty for patients who have aesthetic, functional, or both problems after a previous rhinoplasty. Here are the most common situations I encounter in my office in Londrina:
Aesthetic problems
Crooked or asymmetric nose: deviation of the dorsum, asymmetric tip, or unequal nostrils that persist or appeared after the first surgery.
Irregularities on the dorsum: bumps, depressions, visible "inverted V" or excessively scooped dorsum (saddle nose).
Dropped or retracted tip: loss of projection of the nasal tip due to excessive cartilage removal or lack of support.
Pincered or artificial tip: unnatural appearance caused by excessive sutures or inadequate removal of the alar cartilages.
Overly turned-up nose: excessive shortening with exposure of the nostrils in frontal view.
Overly reduced nose: excessive removal of structures that resulted in a nose too small for the face.
Collapse of the side walls: the middle third of the nose appears pinched, with an hourglass appearance.
Functional problems
Nasal obstruction: difficulty breathing caused by collapse of the internal or external nasal valve, residual septal deviation, or internal scarring.
Alar collapse on inspiration: the side walls of the nose collapse during deep inspiration, blocking the airflow.
Synechiae: scar adhesions inside the nose that obstruct the airway.
Septal perforation: hole in the nasal septum that causes crusting, bleeding, and wheezing when breathing.
The right time to operate
I recommend waiting at least twelve months after primary rhinoplasty before considering a revision. This period is crucial for two reasons: first, the nose needs time for the residual swelling to completely disappear and the final result to manifest. Second, the scar tissue needs to mature so that the dissection in the second surgery is safer and more predictable. An exception is made when there is severe respiratory obstruction that cannot wait.
My approach: structured rhinoplasty with cartilage grafts
Over two decades, I have refined an approach to secondary rhinoplasty based on the concept of structured rhinoplasty. Instead of simply removing more tissue from an already weakened nose, my philosophy is to reconstruct: to restore the support that the nose has lost, correct the deformities, and create a harmonious and natural shape that also allows for free breathing.
Open access: complete view for precise work
In the vast majority of secondary rhinoplasties, I use the open technique (also called external rhinoplasty). A small incision in the columella — that strip of skin between the nostrils — allows me to lift all the skin of the nose and directly visualize the structures that I need to correct. This complete view is essential when dealing with a previously operated nose, with distorted anatomy and fibrosis. The scar from the incision in the columella becomes practically invisible in a few weeks.
Sources of cartilage for grafts
The choice of the donor area for cartilage depends on the amount of material needed and the complexity of the reconstruction:
Nasal septum: when there is sufficient residual septal cartilage, it is the first choice. It is the easiest to shape and has minimal morbidity. However, in previously operated noses, the septum has often already been used in the first surgery.
Auricular concha (ear): ear cartilage is excellent for grafts in the nasal tip, alar reinforcement, and camouflaging irregularities. The removal is done through an incision behind the ear, without altering its external appearance. I provide a moderate amount of cartilage.
Rib: in more complex cases, when I need a large amount of cartilage for extensive reconstruction — such as rebuilding the entire nasal dorsum or creating new support for the tip — I use costal cartilage. The removal is done through a small incision in the chest area, usually at the transition between cartilage and bone of the sixth or seventh rib. It is an abundant, firm, and extremely versatile material.
Types of grafts I use
Each problem requires a specific graft. The most common in my practice include:
Spreader grafts: rectangles of cartilage placed between the septum and the upper lateral cartilages. They correct the collapse of the internal nasal valve and eliminate the "inverted V" appearance on the dorsum.
Columellar graft (strut): a pillar of cartilage placed between the tip cartilages to provide projection and support. Essential when the tip has dropped after the first surgery.
Shield grafts: define the nasal tip, creating controlled projection and refinement.
Alar batten grafts: reinforce the side walls of the nose, preventing collapse during inspiration.
Dorsal graft: I reconstruct the nasal dorsum when there is significant depression or irregularity.
Camouflage grafts: thin layers of cartilage or temporal fascia that smooth visible irregularities under the skin.
Most common problems I correct in secondary rhinoplasty
Each nose I receive for revision tells a different story. But over the years, I have identified patterns that repeat. Understanding these patterns is essential to offer the best solution.
Saddle nose (depressed dorsum)
This occurs when there has been excessive removal of the dorsum in the first surgery, or when the cartilaginous septum has lost support and sagged. The nose takes on a concave appearance, sunken in the central part. The correction involves reconstructing the dorsum with sculpted rib cartilage graft, restoring the natural profile without creating an artificial nose.
Persistent crooked nose
Nasal asymmetry after rhinoplasty can have various causes: residual septal deviation, displacement of grafts, asymmetric fracture of the nasal bones, or uneven healing. In revision, I need to identify each component of the curvature and correct it individually. Sometimes it is the septum that needs to be straightened again. Other times, it is the tip cartilages that are asymmetric. Often, it is a combination of factors.
Dropped or non-projected tip
One of the most frequent complaints. The tip of the nose loses projection when the alar cartilages have been excessively reduced or when the support of the tip was not adequately reconstructed in the first surgery. I use support grafts — such as the columellar strut and the shield graft — to restore projection and definition to the tip in a lasting way.
Pincered tip
When the alar cartilages have been excessively narrowed or sutured too tightly, the tip takes on a pinched, unnatural appearance. The correction involves releasing the constricted cartilages, interposing grafts to open the tip, and reconstructing the alar support with battens. It is one of the most rewarding problems to correct, as the result completely transforms the appearance of the nose.
Nasal valve collapse
The nasal valve is the narrowest region of the nasal airway. When the cartilages that support this area are weakened by previous surgery, the valve collapses during inspiration, causing respiratory obstruction. Spreader grafts and alar batten grafts are the most effective solutions for this problem. In addition to improving breathing, these grafts often also correct the aesthetic appearance of the middle third of the nose.
Supratip (bump above the tip)
When the dorsum of the nose appears higher than the tip, a protrusion called supratip is created. This can occur due to excessive scarring or lack of projection of the tip. The strategy depends on the cause: if it is excess scar tissue, I perform careful resection; if it is lack of projection of the tip, I use grafts to project it above the level of the dorsum.
The relationship with primary rhinoplasty and other procedures
It is important to clarify that not every primary rhinoplasty results in the need for revision. The vast majority of patients are satisfied with the result of the first surgery, especially when performed by an experienced plastic surgeon with the appropriate technique. My own revision rate in primary rhinoplasty is very low, precisely because I use the structured technique from the beginning, preserving and reconstructing support instead of just removing cartilage.
However, when the first surgery does not achieve the expected result — whether due to technical limitations, healing complications, or misaligned expectations — secondary rhinoplasty is the way to definitive correction.
Procedures I can associate with secondary rhinoplasty
Depending on the individual needs of each patient, I can perform other procedures at the same surgical time:
Septoplasty: correction of septal deviation when there is an associated functional component.
Mentoplasty: the balance between the nose and chin is fundamental for profile harmony. A retruded chin can make the nose appear larger than it actually is.
Turbinate reduction: reduction of the nasal turbinates when they contribute to respiratory obstruction.
Lip lift: shortening the upper lip complements the result of rhinoplasty, especially when the distance between the nose and lip is excessive.
Secondary rhinoplasty versus other types of rhinoplasty
If you are researching different types of rhinoplasty, it is worth knowing the variations I offer:
The consultation for secondary rhinoplasty: more detailed than any other
The consultation for revision rhinoplasty is significantly longer and more detailed than for primary rhinoplasty. I need to understand not only what you desire but also what was done previously, how your nose healed, and what the real possibilities for improvement are.
What I evaluate in the consultation
Surgical history: when the first surgery was, what technique was used, if there were complications. I always ask the patient to bring the previous surgical report when available.
Pre-operative photographs: photos from before the first surgery are extremely valuable for understanding the original anatomy of the nose.
Detailed external evaluation: I examine each subunit of the nose — dorsum, tip, alar base, columella, lateral walls — looking for asymmetries, irregularities, and deformities.
Internal evaluation: with a nasal speculum, I check the septum, valves, turbinates, the presence of synechiae or septal perforations.
Valvular collapse test: I assess whether the lateral walls collapse during inspiration, which indicates the need for spreader grafts or alar battens.
Skin quality: thin versus thick skin drastically influences planning and expectations.
Amount of available cartilage: I palpate the septum to estimate how much material remains. This determines whether I will need cartilage from the ear or rib.
Honesty about expectations
I am absolutely honest with my patients: secondary rhinoplasty can significantly improve the appearance and function of the nose, but it is not always possible to achieve perfection. Scar tissue, lack of cartilage, and skin limitations impose restrictions that do not exist in primary rhinoplasty. When I perceive that the patient's expectations are unrealistic, I prefer to say this clearly in the consultation rather than perform a surgery that will result in frustration.
The surgery step by step
Secondary rhinoplasty lasts between three and five hours, depending on the complexity of the case. It is performed under general anesthesia in a properly equipped surgical center.
Cartilage harvesting
When ear grafting is necessary, I start by harvesting cartilage from the auricular concha through an incision behind the ear. When reconstruction requires costal cartilage, I make an incision of about three centimeters in the chest area to access the rib cartilage. The scar is small and hidden under the bra line in women.
Access and dissection
Through the incision in the columella and marginal incisions inside the nostrils, I carefully lift the skin envelope of the nose. Dissection in a previously operated nose is slower and more meticulous, as I need to identify and preserve structures amidst scar tissue. Each anatomical plane is carefully separated.
Intraoperative evaluation and planning
With the nose open, I directly assess the state of the remaining cartilages, the septum, the valves, and the internal scars. Often, what I find differs from what the external evaluation suggested. It is at this moment that the surgical plan can be adjusted to meet the real needs.
Structural reconstruction
This is the most important and time-consuming step. I sculpt the cartilage grafts as needed: spreader grafts to open the middle third, columellar strut to project the tip, alar battens to reinforce the lateral walls, dorsal graft to correct depressions. Each graft is secured with precise sutures, ensuring long-term stability.
Refinement and closure
After structural reconstruction, I make the final adjustments: shaping sutures on the tip, camouflage grafts when necessary, reduction of alar base if indicated. Closure is done in multiple layers with fine threads. I apply an external nasal splint (aquaplast) that will remain for seven to ten days.
Recovery from secondary rhinoplasty
The recovery from revision rhinoplasty is similar to that of primary rhinoplasty, although in some cases there may be a bit more swelling due to the presence of previous scar tissue.
First week
You will wear the nasal splint and, eventually, internal silicone plugs for one to two days. There will be swelling and bruising around the eyes, which begin to improve from the third day. Keep your head elevated, apply cold compresses, and take the prescribed medication strictly.
Second week
After the splint is removed, the nose will still be swollen, but it will already show a significantly better shape than before. Most bruising will have disappeared. You may resume light activities and use makeup with care.
First to third month
Swelling decreases progressively. The tip of the nose is the last area to completely de-swell. Avoid wearing heavy glasses directly on the nasal dorsum, intense sun exposure, and activities that may cause trauma to the nose.
Six months to a year
The result gradually refines. The skin settles over the new structure, the internal scars mature, and the final shape of the nose is defined. In thicker skins, this process can take up to eighteen months. Patience is an essential virtue during this period.
Specific post-operative care
Avoid blowing your nose forcefully in the first three weeks.
Sleep with your head elevated for at least two weeks.
Do not wear glasses resting on the nose for six weeks (use a protector or secure with micropore on the forehead).
Avoid intense exercise for four to six weeks.
Use sunscreen on the nose daily for at least six months.
Attend all follow-up appointments as scheduled.
Why patients from other cities seek me for revision
I receive patients weekly from Curitiba, Maringá, Cascavel, São Paulo, Campinas, Ribeirão Preto, Belo Horizonte, and many other cities who travel to Londrina specifically for secondary rhinoplasty with me. This happens for several reasons that I humbly wish to mention.
Accumulated experience
Over more than twenty years, I have accumulated experience in hundreds of revision rhinoplasties. Each secondary nose is different, but the patterns of problems repeat. This experience allows me to quickly recognize what was done, what went wrong, and what the best correction strategy is.
Solid training
I was a student of Professor Ivo Pitanguy, the greatest name in Brazilian plastic surgery. I am a full member of the Brazilian Society of Plastic Surgery (SBCP) and the American Society of Plastic Surgeons (ASPS). I constantly keep myself updated by participating in national and international congresses and studying the latest techniques.
Honest approach
I do not promise miracles. If your case is simple, I will say it is simple. If it is complex, I will explain each challenge and each limitation. If I perceive that the surgery will not deliver what you expect, I will say this before operating. This honesty, over the years, has built a reputation that attracts patients who have already been disappointed by unrealistic promises from other professionals.
Proper structure
My clinic in Londrina offers all the necessary structure for a detailed consultation, with adequate time to examine your nose, discuss options, and calmly plan the surgery. The surgery is performed in a complete surgical center, with an experienced anesthesia team and all the necessary equipment for complex procedures.
Risks and Complications
Like any surgery, secondary rhinoplasty has risks. Being transparent about them is an ethical obligation that I take very seriously.
General Risks
Bleeding: controlled with nasal packing when necessary.
Infection: rare with adequate antibiotic prophylaxis.
Anesthesia reaction: minimized by rigorous pre-anesthetic evaluation.
Hematoma: uncommon, but may require drainage.
Specific Risks of Revision
Result below expectations: scar tissue and lack of cartilage limit what can be achieved. I discuss this extensively during the consultation.
Residual asymmetry: some degree of asymmetry may persist, especially in complex cases.
Need for another procedure: in a small percentage of cases, an additional touch-up may be necessary.
Partial absorption of grafts: cartilage grafts may experience partial absorption over the years, although this is rare with proper fixation technique.
Scars at the donor site: harvesting cartilage from the ear or rib leaves discreet scars, but they do exist.
How I Minimize Risks
My approach to minimizing risks includes: meticulous surgical planning, exclusive use of autologous cartilage (from the patient, without synthetic materials), secure fixation of grafts with sutures, careful dissection respecting anatomical planes, and rigorous postoperative follow-up for at least one year.
Frequently Asked Questions about Secondary Rhinoplasty
How many times can I have my nose operated on?
There is no defined maximum number, but each additional surgery increases complexity and reduces the availability of cartilage. In most cases, well-planned and executed secondary rhinoplasty definitively resolves the issues. In rare cases, a third procedure may be necessary for minor adjustments. My goal is always to resolve everything in a single revision.
Is secondary rhinoplasty more painful than primary?
The pain is similar. When I use rib cartilage, there may be additional discomfort at the harvesting site for a few days, adequately controlled with pain medication. The nasal discomfort itself is comparable to that of the first surgery.
Can I correct aesthetic and functional problems at the same time?
Yes, and in fact, it is ideal. In most cases of secondary rhinoplasty, aesthetic and functional problems are interconnected. A nose with valve collapse both breathes poorly and has an unnatural appearance. By correcting the structure with grafts, I simultaneously improve both form and function.
Is the result of secondary rhinoplasty permanent?
Yes, in the vast majority of cases. The reconstructed structure with autologous cartilage grafts is permanent. Cartilage is not absorbed when well vascularized and fixed. The nose will continue to age naturally with you, but the structural corrections are lasting.
Do I need to use rib cartilage? Can't I use another material?
Rib cartilage is only necessary in more complex cases that require a large amount of material for reconstruction. Whenever possible, I use cartilage from the residual septum or the ear. I do not use synthetic materials like silicone or Medpor for nasal reconstruction, as the risk of infection, extrusion, and long-term rejection is significantly higher compared to autologous cartilage.
How long after the first rhinoplasty can I have the revision?
I recommend waiting at least twelve months. This period allows residual swelling to completely disappear, scar tissue to mature, and the definitive result of the first surgery to manifest. Operating before this timeframe increases the risk of complications and makes it difficult to accurately assess what needs to be corrected.
Is the scar on the columella visible?
The incision on the columella is made in an "inverted V" or "step" shape and heals in a practically imperceptible way in most patients. In two to four weeks, it is already difficult to identify. It is a very small price to pay for the complete view that open access provides to the surgeon.
Can I have secondary rhinoplasty with a different surgeon than the first?
Yes, and this is very common. Most of my revision patients were initially operated on by another surgeon. There is no ethical or technical impediment. The important thing is that the revision surgeon has specific experience in this type of procedure. I always request the report of the previous surgery when available, but I can plan the revision even without it.
Can secondary rhinoplasty improve my breathing?
In most cases, yes. Nasal obstruction after rhinoplasty is often due to nasal valve collapse or residual septal deviation, problems that are corrected during the revision with structural grafts. Many patients report that after the revision, they breathe better than at any point in their lives.
How much does secondary rhinoplasty cost?
The investment in revision rhinoplasty is generally higher than that of primary rhinoplasty, as the procedure is longer, technically more complex, and often requires harvesting cartilage from a donor site. The exact amount depends on the complexity of the case and associated procedures. During the consultation, after evaluating your nose and defining the surgical plan, I will inform you of the detailed investment.
Is secondary rhinoplasty covered by health insurance?
When there is a proven functional component — such as nasal obstruction due to valve collapse or residual septal deviation — part of the procedure may be covered by health insurance. The aesthetic part is generally not covered. I guide each patient individually about this possibility during the consultation.
Schedule via WhatsApp
If you have made it this far, it is because you are seriously considering secondary rhinoplasty. The next step is simple: schedule a consultation with me. My team is ready to assist you, answer your questions, and find the best time for your evaluation.
