Revision Rhinoplasty

Revision rhinoplasty is a rhinoplasty surgery performed on a patient who has had one or more previous rhinoplasty procedures with unsatisfactory results.

It is a very different operation that a primary (first time) rhinoplasty. It is more complex and requires a higher level of expertise as well as extensive experience in nasal surgery. Dr. Samaha is one of the most experienced rhinoplasty and revision rhinoplasty surgeons in Montreal.

Revision rhinoplasty is performed to correct a poor esthetic result, breathing difficulty, or both.

  • Poor esthetic results after rhinoplasty are often a consequence of removing too much cartilage or bone creating unsightly sharp edges, hollows, shadows, or poor shape overall.
  • Breathing difficulty after rhinoplasty can occur in some patients who have weak cartilage. If this is not recognized prior to the procedure, surgery can cause further weakness or collapse of those cartilages.

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Choosing a Revision Rhinoplasty Surgeon in Montreal

Rhinoplasty is a complex and delicate procedure that requires extensive skill and experience in nasal surgery. Revision rhinoplasty is even more demanding given its added complexity. It requires not only experience but more advanced techniques. Therefore, the surgeon should preferably be specialized in nasal surgery and perform a large number of procedures.

Dr. Samaha specializes exclusively in facial surgery and has performed over 2500 rhinoplasties, both primary and revision. He has extensive experience in analyzing the nose, diagnosing the causes of esthetic deformities, and devising a plan to correct the patient’s specific issues.

Dr. Mark Samaha

Meet Dr. Mark Samaha

A double board-certified otolaryngologist whose practice focuses exclusively on facial plastic surgery, Dr. Samaha is highly qualified in facial aesthetics. Learn more about our physician and how he's carefully refined his skills to sculpt your beautiful face.

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The Right Diagnosis and Plan

The most important factor in obtaining a good result in rhinoplasty, whether primary or revision is the surgeon’s ability to recognize the problem with the nose and devise the correct plan for proper correction.

The ability to analyze a nose that has previously been operated on for esthetic defects or identify areas of poor support causing breathing difficulties is in fact a complex skill which comes from specialized expertise and years of experience.

Disappointing results in rhinoplasty, including revision rhinoplasty, are usually due to incorrect diagnosis of the problem, which leads to the use of the incorrect maneuvers and techniques.

Minor Revisions vs. Major Revisions

A minor revision is usually a touch up procedure. For example, a hump was removed in the primary surgery and several months of healing later, a small irregularity or a residual minor hump still remains. In such an instance, a touch up procedure can be undertaken to “file down” the remaining hump or small irregularity. Such a revision procedure is simple, short, and yields a very predictable result.

A major revision is a more complex procedure and is usually performed after an unsuccessful rhinoplasty that resulted in a significant esthetic deformity and/or breathing difficulty. This is frequently due to some surgeons making the incorrect diagnosis or using older techniques where excessive tissue (cartilage, bone) is removed. This frequently leads to collapse of certain areas of the nose and significant scarring that then need to be addressed with a revision surgery.

Grafts in Revision Rhinoplasty

A graft is material placed by the surgeon in an area of the nose to correct or compensate for a deficiency. A graft can be the patient’s own cartilage or bone taken from elsewhere in the body or it can be foreign material, called an implant, such as silicone or Gore-Tex.

The Patient’s Own Cartilage as Grafts

In the case of the patient’s own tissue, the most common tissue grafted is cartilage. Cartilage is used in revision rhinoplasty to correct imperfections, replace excessive cartilage removed in the previous surgery, and help correct any collapse causing breathing problems.

When grafts are needed, the best cartilage for grafting in the nose is cartilage taken from the septum inside the nose itself. The septum is a wall made of bone and cartilage, which separates the two sides of the nose.

ORL surgeons (otolaryngologists) are trained and experienced in surgery on the septum as they routinely perform septoplasty (surgery aimed at fixing deviations of the septum to improve breathing). It is therefore very easy and simple for them to collect cartilage from this area of the nose to be used for grafting. A surgeon with limited or no training in septal surgery will often favour taking cartilage from the ear. While adequate, this ear cartilage is not as good as the cartilage coming from the septum.

Implants in Revision Rhinoplasty

Some surgeons use implants, most commonly silicon or Gore-Tex, as grafts. While many surgeons have success with these implants, Dr. Samaha does not use them in his practice. There is a risk of infection and rejection with implants that almost never happens with the patient’s own cartilage. In addition, infection, rejection, or movement of the implant can occur years later, even after a long period without problems.

When such a complication occurs, the implant needs to be removed and any infection treated. Unfortunately, this means that the original defect that the implant corrected still needs to be addressed. Furthermore, the infection and the healing that follows its treatment causes further scarring making the subsequent surgery to replace the implant more difficult.

Dr. Samaha’s Approach to Revision Rhinoplasty

In order to obtain the best possible result for his patients, Dr. Samaha’s goal in revision surgery is to address the visible esthetic issues and improve any breathing difficulties while avoiding creating new problems with the nose. The most important thing is to strike the ideal balance between fixing the specific areas of concern while avoiding disruption of the parts of the nose that look good.


Dr. Samaha has developed techniques and methods to minimize swelling and bruising after surgery for his patients to shorten their recovery. This has culminated in his Maximum Result Minimum Recovery system.

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Is revision rhinoplasty more complicated than primary rhinoplasty?

Revision rhinoplasty is more complex than primary rhinoplasty for several reasons:

  • The healing and scarring that takes place after the prior rhinoplasty procedure(s) make the revision surgery more challenging.
  • The previous surgery has changed the shape and anatomy of the nasal cartilages and bones.
  • In some cases, too much cartilage or bone was removed by the previous surgeon and these tissues are missing from areas where they are supposed to be.
  •  The previous surgeon may have placed grafts, which are pieces of cartilage taken from elsewhere in the nose or from the ears and placed them in areas of the nose where they are not naturally present. These can also alter the anatomy of that area of the nose or present complications related to the grafts themselves.

Am I a candidate for revision rhinoplasty?

There are a few factors which make one a good candidate for revision rhinoplasty:

  • Visible imperfections that can be improved. This is the case for most patients. However, very minor imperfections that are barely visible can seldom be corrected perfectly.
  • Breathing difficulties resulting from the previous rhinoplasty surgery. This is often due to collapse of certain cartilages in the nose that need to be reinforced or rebuilt.
  • Having realistic expectations. This is very important as patients seeking revision rhinoplasty have already been disappointed by the result of the initial procedure. It is therefore important to enter the process with realistic expectations as to what is achievable to avoid being disappointed again.

Very rarely, in certain patients who have thin delicate skin and have undergone 3, 4 or more previous rhinoplasty surgeries, the skin and tissues have become more fragile and may not be strong enough to withstand another surgery. Dr. Samaha may advise these patients against having another surgical procedure.

Patients who have medical conditions that make surgery of any kind risky to their health are, of course, not good candidates.

What are my options if I am not a candidate for revision rhinoplasty?

One good option for patients who are not good candidates for surgery is non-surgical rhinoplasty. In such patients, this can be an excellent opportunity to achieve a significant improvement without surgery.

What is the result of revision rhinoplasty?

In skilled, experienced hands, and with the patient having realistic expectations, revision rhinoplasty can lead to significant improvement. An excellent result can usually be achieved.

Is recovery from revision rhinoplasty longer than the initial surgery?

The length of recovery will depend on the type of revision performed. In addition, Dr. Samaha uses minimally invasive anesthesia and surgical techniques he has worked on and perfected over a 20-year period to minimize swelling, bruising, and recovery. This approach, which he has called Maximum Result Minimum RecoveryTM allows for a much shorter recovery than the usual method. In addition, Dr. Samaha’s use of a closed rhinoplasty approach further helps minimize the recovery period.

Depending on whether it is a major revision or a minor one, the recovery time from rhinoplasty surgery will vary. In our facial plastic surgery clinic in Montreal, minor revisions will usually be associated with a short recovery of 4-5 days or less. A major revision involving significant work on multiple aspects of the nose will more likely be associated with a recovery of 10-12 days.

Is revision rhinoplasty painful?

No. Pain does not depend on whether it is a primary rhinoplasty or revision rhinoplasty surgery. Rather, pain is dependent on multiple factors:

  • The surgical technique used. If the surgeon causes a lot of injury to the tissues, this leads to more inflammation during the healing phase after surgery and more inflammation can lead to more pain
  • The #1 cause of pain after rhinoplasty is the use of nasal packing. Nasal packing is usually gauze or sponges inserted deep in the nose after surgery. The practice of placing packing dates back over 50 years and is unfortunately still used by many surgeons today. Back then, the surgery was not as delicate, and packing was placed to ostensibly prevent bleeding after surgery. Today, it should be quite unnecessary as a delicate surgical technique should not be associated with any bleeding after surgery.

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Want to learn more about revision rhinoplasty? Request your consultation with Dr. Samaha online or call us at (514) 900-2239 to make your appointment. Dr. Samaha attracts patients from Quebec City, Laval, and Gatineau.

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