Secondary rhinoplasty differs from the primary procedure in that it may require cartilage or bone grafting. If too much tissue or bone was removed in the first surgery, the doctor will need to replace this in order to achieve the desired look. Often, cartilage is taken from the ear or other areas of the nose. In rare cases, it is harvested from a rib, in what is known as a costal cartilage graft.
Case 72: This patient had sustained a nasal fracture that caused a significant deviation of her nose. The fracture was corrected along with a septoplasty to improve breathing. Loss of tip support after the injury made her hump look more prominent and her tip felt more droopy. The bump was smoothened and her tip angulation restored to create the softer, more feminine profile she wanted. At the same time, fat transfer to the cheek and under eye area and subtle neck liposuction substantially improved the flat cheek and mid-face contour that previously made her feel hollowed and tired looking without makeup. 

As with almost all forms of plastic surgery, there is a possibility for scarring following rhinoplasty. In closed rhinoplasty, all incisions are made inside the nostrils and will therefore not leave behind any visible scars. In open rhinoplasty, an additional incision made across the columella may leave a small scar behind. Fortunately, due to the size and location of the incision this scar is usually unnoticeable.
Rhinoplasty can be performed in one of three places: private surgical suites, ambulatory surgical centers, or hospitals. You should speak with your surgeon and make certain that their chosen venue has been accredited by an organization such as the American Association for Accreditation of Ambulatory Surgical Facilities (AAAA), the Accreditation Association for Ambulatory Health Care (AAAHC), or the Joint Commission for Accreditation of Healthcare Organizations (JCAHO).
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