Revision Rhinoplasty


Introduction to Revision Rhinoplasty

Revision Rhinoplasty refers to secondary Rhinoplasty, or surgery performed after another attempt is made.  Revision rhinoplasty is a challenging surgical procedure and patients are encouraged to have a thorough conversation with their potential surgeon to ensure that their goals are likely achievable.

Common goals in revision rhinoplasty are to compensate for a new defect that is visible in the nose after the prior surgery.  Some patients may also seek to improve their nasal breathing through a successful revision rhinoplasty.  The best way to learn about a revision rhinoplasty is through a consultation with a board-certified surgeon who performs this surgery frequently, like Dr. Pepper.

Dr. Pepper’s Philosophy of Revision Rhinoplasty

As a double board-certified surgeon, Dr. Pepper’s goal is to restore form and function in a manner that is harmonious with the rest of the face.  For example, the patient shown below desired restoration to the bridge of the nose, having had an over-aggressive endonasal rhinoplasty performed by another surgeon.  In order to effectively recontour the bridge, cartilage was obtained from the rib and used to rebuild the bridge of the nose.  The nasal tip was likewise reconstructed both with rib cartilage and also refined and shaped through the use of carefully placed sutures to improve the overall contour and eliminate the sharp ridges that were visible prior to revision surgery.  The final result is a more natural profile, fewer asymmetries and irregularities, and better breathing.  

About Revision Rhinoplasty Surgery

In general, revision rhinoplasty is performed via an external approach.  The advantages of the open approach include higher accuracy for the placement of cartilage grafts and tip sutures.  Given the need to restore nasal anatomy in revision surgery, the external approach is therefore often more useful for a revision rhinoplasty.

What is Different About Revision Rhinoplasty in Comparison to Primary Rhinoplasty?

As alluded to above, revision rhinoplasty may require the use of cartilage or other tissues from other sites on the body.  Rib cartilage, for example, is useful in major revision surgeries.  However, not all revision rhinoplasties require these materials for a successful outcome.

What Can I Expect After Revision Rhinoplasty?

Patients are asked to limit their activity in the first several weeks after rhinoplasty and to ice the nose to limit bruising.  Pain should be well controlled with prescribed medication.  Most patients are comfortable working from home the second week after surgery, but this depends on the patient and the extent of surgery.  A cast is placed on the bridge of the nose to limit swelling and also to protect the nose from accidental contact.  Soft silicone splints are kept inside the nose to speed internal healing.  Both the case and the splint are removed one week after surgery.  Patients typically return to work one to two weeks after a rhinoplasty, but this can vary depending on occupation and other factors.

How Does One Decide on a Rhinoplasty?

One of the most helpful ways to decide on a rhinoplasty is to undergo a “virtual rhinoplasty” during a cosmetic consultation using digital imaging software under the guidance of your potential surgeon.  The second part of that statement is important: your consulting surgeon can model results for you that are reasonable and achievable.  Anyone can manipulate a digital image. However, a very experienced surgeon like Dr. Pepper can help you to visualize a likely outcome in his hands.  If you would like a revision rhinoplasty consult, please call us at (650) 736-3223 (FACE).


Schedule a Consultation

(650) 736-FACE (3223)

Jon-Paul Pepper, MD
Associate Professor of Otolaryngology — Head & Neck Surgery


Dr. Pepper is a double-board certified surgeon who specializes in aesthetic and reconstructive surgery of the face, in particular surgery for the treatment of facial paralysis. He is the Director of the Stanford Facial Nerve Center since 2017. He has broad expertise in facial plastic and reconstructive surgery, including facial reanimation surgery, facelift surgery, rhinoplasty, and the reconstruction of the face after skin cancer resection. Dr. Pepper performed his undergraduate studies at Brown University, majoring in Neuroscience. He completed a one-year research fellowship at the National Institutes of Health in preparation for a career in academic medicine. He was awarded his M.D. at the University of California, Irvine, graduating with highest honors and Alpha Omega Alpha designation in 2007. He went to the University of Michigan for residency training in Otolaryngology – Head & Neck Surgery in 2012. He then completed fellowship training in Facial Plastic & Reconstructive Surgery in 2013, also at the University of Michigan. Dr. Pepper was honored to receive the highest board score in the nation on the American Board of Facial Plastic & Reconstructive Surgery examination in 2013. For this accomplishment, he was given the Jack R. Anderson Award for Scholastic Achievement. He also directs the scientific work of the Stanford Facial Nerve Center and his NIH-funded research explores regenerative strategies to improve nerve regeneration after injury.