Rhinoplasty, commonly known as a "nose job," is one of the most popular cosmetic procedures in the United States, with thousands of people seeking it each year to enhance their appearance or improve breathing. According to the American Society of Plastic Surgeons, rhinoplasty consistently ranks as one of the top five cosmetic surgeries in the U.S. However, as with any surgical procedure, rhinoplasty comes with its challenges. When things go wrong, the consequences can be both cosmetic and functional, often requiring revision surgery to correct issues.

One of the most important steps in preventing these problems is choosing the right surgeon. Board-certified plastic surgeons or otolaryngologists (ear, nose, and throat specialists) with specialized training in rhinoplasty are the most qualified professionals to perform these surgeries. These doctors are trained to address both the aesthetic concerns of the patient while also preserving or improving the structural integrity and function of the nose.

Cosmetic rhinoplasty focuses on enhancing the appearance of the nose, such as refining the shape, size, or symmetry. Functional rhinoplasty, on the other hand, addresses structural problems that affect breathing, such as a deviated septum or nasal valve collapse. Both procedures require a delicate balance—cosmetic changes should not compromise the ability to breathe, and any functional improvements must also maintain the nose's natural appearance.

Experienced rhinoplasty surgeons are trained to respect the nasal airway and maintain the nose’s structural support while addressing cosmetic concerns, ensuring both form and function are preserved. However, not every rhinoplasty goes as planned, and that's where the challenges of secondary rhinoplasty come in.

Why Secondary Rhinoplasty is More Difficult

Secondary rhinoplasty, also called revision rhinoplasty, is significantly more challenging than primary (first-time) rhinoplasty. The main reason is that the tissue, cartilage, and bone have already been altered, often leading to scar tissue, weakened structural support, and compromised blood supply. As a result, fixing problems from a previous surgery requires more precision and expertise. This is why it’s crucial to choose an experienced rhinoplasty surgeon for revision cases—they have the skills and knowledge to navigate the complexities of secondary rhinoplasty.

Common Problems After Rhinoplasty and How to Fix Them

While many rhinoplasty procedures go smoothly, some patients experience complications or unsatisfactory results. Here are some common problems that can occur after rhinoplasty and the techniques used to fix them:

Problem 1: Breathing Problems After Surgery

Breathing difficulties are one of the most common functional issues after rhinoplasty. These can be caused by a deviated septum, issues with the internal or external nasal valves, or a compromised nasal skeleton.

How To Fix It

• Correcting the deviated septum can help improve airflow.
• If the internal or external nasal valves are collapsed, cartilage grafts can be used to open them up.
• In cases where the structural integrity of the nose is compromised, rebuilding the nasal skeleton using cartilage grafts or structural supports is necessary to restore both function and appearance.

Problem 2: Hanging Columella

A hanging columella occurs when the strip of tissue between the nostrils (the columella) protrudes too far, causing an unbalanced look. This is often due to inadequate support of the nasal tip.

How To Fix It

• The solution involves supporting the columella and the tip of the nose with cartilage grafts.
• In some cases, the hanging part of the columella may need to be trimmed to achieve a more balanced appearance.

Problem 3: Inverted V Deformity

An inverted V deformity is a visible collapse or narrowing of the upper part of the nose, often caused by over-reduction of the dorsal hump and inadequate support for the nasal cartilage. This gives the nose a pinched appearance.

How To Fix It

• Spreader grafts (cartilage placed between the septum and upper lateral cartilages) are used to correct the deformity, restoring both the appearance and function of the nose by widening and supporting the nasal sidewalls.

Problem 4: Polybeak Deformity

A polybeak deformity refers to a fullness or bump just above the nasal tip, resembling a parrot’s beak. This can be caused by under-resection of cartilage, over-reduction of the dorsal hump, or poor support of the nasal tip.

How To Fix It

• The treatment involves reducing the area above the tip while reinforcing the tip support with cartilage grafts. The specific approach depends on whether the fullness is due to excess cartilage or poor tip support.

Problem 5: Over-rotated Tip and Short Nose

An overrotated tip results in a nose that appears short or turned up, often giving a "pig-like" appearance. This can occur when too much cartilage is removed from the tip, or the tip is positioned too high on the nasal dorsum.

How To Fix It

• The solution usually involves adding cartilage grafts to lengthen the nose and rotate the tip downward to a more natural position.

Problem 6: Crooked or Asymmetric Nose

A crooked nose or asymmetry can result from uneven cartilage removal, failure to correct a deviated septum, or scar tissue pulling the nose to one side.

How To Fix It

• Fixing a crooked nose involves a combination of techniques, such as straightening the septum, correcting any asymmetry in cartilage removal, and in some cases, releasing scar tissue that is pulling the nose off-center.

 The Importance of an Experienced Rhinoplasty Surgeon

Secondary rhinoplasty is one of the most challenging cosmetic procedures due to the need to correct both functional and aesthetic issues that have already been altered in previous surgeries. Whether you’re experiencing breathing problems, a hanging columella, an inverted V deformity, or other complications, it is crucial to seek out a highly experienced rhinoplasty surgeon with a deep understanding of nasal anatomy and revision techniques.

If you're considering secondary rhinoplasty or need corrective surgery, always consult with a board-certified plastic surgeon or an otolaryngologist specializing in rhinoplasty to ensure the best possible outcome.