{"id":13493,"date":"2026-09-26T16:56:29","date_gmt":"2026-09-26T14:56:29","guid":{"rendered":"https:\/\/drmarcoromeo.com\/revision-rhinoplasty\/"},"modified":"2026-09-26T16:56:29","modified_gmt":"2026-09-26T14:56:29","slug":"revision-rhinoplasty","status":"publish","type":"page","link":"https:\/\/drmarcoromeo.com\/en\/revision-rhinoplasty\/","title":{"rendered":"Revision rhinoplasty in Madrid: secondary and tertiary rhinoplasty, rebuilding a nose that has already been operated on"},"content":{"rendered":"<div class=\"wpb-content-wrapper\" id=\"wpb-content-root\"><p>[vc_row content_placement=&#8221;top&#8221;][vc_column][vc_single_image image=&#8221;10589&#8243; img_size=&#8221;full&#8221; css=&#8221;&#8221;][\/vc_column][\/vc_row][vc_row][vc_column]<div   class=\"gem-quote gem-quote-style-default \" ><blockquote  >&#8220;A nose that has already been operated on is not touched up: it is rebuilt. It has to be given back the structure, the support and the covering it lost.&#8221;<\/blockquote><\/div>[\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=&#8221;What is revision rhinoplasty: secondary and tertiary&#8221; use_theme_fonts=&#8221;yes&#8221; css=&#8221;&#8221;][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text css=&#8221;&#8221;]<strong>Secondary rhinoplasty<\/strong> is the surgery that corrects the result of a previous rhinoplasty: a tip that dropped, a bridge that collapsed, a nose that was left crooked or that breathes worse than before. <strong>Tertiary rhinoplasty<\/strong> is the one that comes after two previous operations. Both are also called <strong>revision rhinoplasty<\/strong> or nose re-operation. Unlike a primary rhinoplasty, which reshapes bone and cartilage that are where they should be, here the work is on scarred tissue, cartilage that has already been used and skin that has lost elasticity. That is why it almost always means rebuilding with grafts, not just reshaping.<\/p>\n<p>It does not matter where or when you had your first operation. What matters is how much tissue is left and in what condition.<\/p>\n<p>I am a plastic, aesthetic and reconstructive surgeon specialising in nasal surgery, and I operate in Madrid, Spain.[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text css=&#8221;&#8221;]<\/p>\n<table class=\"romeo-ficha\">\n<tr>\n<th>Anaesthesia<\/th>\n<td>General.<\/td>\n<\/tr>\n<tr>\n<th>Duration<\/th>\n<td>Depends on the case; longer than a primary rhinoplasty.<\/td>\n<\/tr>\n<tr>\n<th>Hospital stay<\/th>\n<td>With or without an overnight stay, depending on the case.<\/td>\n<\/tr>\n<tr>\n<th>Scar<\/th>\n<td>Almost always open: a small incision on the columella that is barely visible.<\/td>\n<\/tr>\n<tr>\n<th>Recovery<\/th>\n<td>Splint for a week; social life after a week; contact sport after two months.<\/td>\n<\/tr>\n<tr>\n<th>Result<\/th>\n<td>The profile within weeks; the final result at twelve months.<\/td>\n<\/tr>\n<tr>\n<th>Price<\/th>\n<td>9,000 to 19,000 \u20ac.<\/td>\n<\/tr>\n<tr>\n<th>Where<\/th>\n<td>Madrid, at HLA Moncloa and Vithas Aravaca.<\/td>\n<\/tr>\n<\/table>\n<p>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=&#8221;Why a first rhinoplasty goes wrong&#8221; use_theme_fonts=&#8221;yes&#8221; css=&#8221;&#8221;][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text css=&#8221;&#8221;]The best rhinoplasty is the one that is done only once in a lifetime, but between 3 and 10 % of rhinoplasties, depending on the series, end up needing a revision. The causes I see most often:<\/p>\n<ul>\n<li><strong>Too much was removed.<\/strong> A bridge lowered too far, a tip stripped of the cartilage that held it up: the nose is left small, pinched or with a saddle-shaped bridge.<\/li>\n<li><strong>It was removed unevenly.<\/strong> Steps, irregularities, an asymmetric tip or a bridge with a ridge you can feel.<\/li>\n<li><strong>No support was given.<\/strong> When a nose with a weak base is reshaped without being reinforced, over the months the tip drops and breathing gets worse.<\/li>\n<li><strong>The septum was left deviated or without cartilage<\/strong>, and with it the nose twists and closes.<\/li>\n<li><strong>A skin problem:<\/strong> thick skin that does not adapt to the new framework, or thin skin that shows every edge.<\/li>\n<\/ul>\n<p>What can be recovered depends on the tissue that is left. A nose that lacks cartilage can be built again; a nose that lacks skin is much harder.[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=&#8221;How many times can a nose be operated on&#8221; use_theme_fonts=&#8221;yes&#8221; css=&#8221;&#8221;][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text css=&#8221;&#8221;]Every operation uses up capital: it uses up cartilage, skin elasticity and blood supply, and that capital does not grow back. So there is no number of operations that marks the limit. I have operated on noses in their fourth or fifth surgery with a good result, and I have advised against a third because the risk outweighed the possible benefit. What is decisive is not how many operations there have been, but how much tissue is left and in what condition.<\/p>\n<p>And there is no hurry: an operated nose takes months to settle, and until the swelling from the first operation has gone it is not possible to know what needs correcting.[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=&#8221;The first consultation and the CT scan&#8221; use_theme_fonts=&#8221;yes&#8221; css=&#8221;&#8221;][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text css=&#8221;&#8221;]Before deciding anything I need to know what was done and what is left. I examine the nose outside and inside, check how you breathe through each nostril and look at photographs from before the first operation and the surgical report of that operation if you have it. For a nose that has already been operated on I request a <strong>CT scan<\/strong>: it shows how much septum is left, the state of the bones and the sinuses, and it is what lets me plan the reconstruction instead of discovering it in theatre. With that I can tell you what can be corrected, what needs rebuilding, where the cartilage will come from and, sometimes, that it is better not to operate again.[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=&#8221;How the surgery is done: rebuilding with your own cartilage&#8221; use_theme_fonts=&#8221;yes&#8221; css=&#8221;&#8221;][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text css=&#8221;&#8221;]In a first rhinoplasty the surgeon works on intact anatomy: reshaping bone and cartilage that are where they should be. Rebuilding a nose is a different discipline: it means giving back structure, support and covering to a nose that has lost them. This is not touching up, it is rebuilding: material has to be brought in, usually the patient&#8217;s own cartilage, to reconstruct the pillars that hold the nose up, restore the airway and, on top of that, achieve a result that looks good.<\/p>\n<p>I almost always do it <strong>open<\/strong>, with a small incision on the columella: I need to see the whole structure to rebuild it.<\/p>\n<div class=\"romeo-medical-note\">\n<p>To work on the bone I use my usual technique, <a href=\"https:\/\/drmarcoromeo.com\/en\/ultrasonic-rhinoplasty-spain\/\">ultrasonic rhinoplasty<\/a>, which allows previously operated bones to be repositioned precisely and with less bruising.<\/p>\n<\/div>\n<p><strong>The septum, the load-bearing beam.<\/strong> Its front part forms an L that holds up the bridge and the tip. When that L is weakened or destroyed, the nose collapses, the typical saddle-nose deformity, and breathing is compromised. Reconstruction means rebuilding that beam with cartilage grafts carved and fixed with millimetre precision. In the most severe cases a subtotal reconstruction of the septum is needed, one of the most complex techniques in nasal surgery.<\/p>\n<p><strong>Where the cartilage comes from.<\/strong> If the septum still has enough cartilage, I take it from there. When it is broken, depleted or was already used in the previous operation, I take a small amount of cartilage from the patient&#8217;s own rib, through an incision of a few centimetres, and with it I rebuild the bridge and the support of the tip. That is what I did in <a href=\"https:\/\/drmarcoromeo.com\/en\/before-after-cases\/secondary-rhinoplasty-clinical-before-after\/tertiary-rhinoseptoplasty-before-after-case-emg211224\/\">this tertiary septorhinoplasty<\/a> and in <a href=\"https:\/\/drmarcoromeo.com\/en\/before-after-cases\/secondary-rhinoplasty-clinical-before-after\/secondary-rhinoplasty-clinical-before-after-case-89050\/\">this secondary rhinoplasty with a rib graft<\/a>.<\/p>\n<p>In the same operation I correct the functional side: the septum, the valve and the turbinates. <strong>An operated nose that breathes badly is not finished.<\/strong>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=&#8221;Septal perforation&#8221; use_theme_fonts=&#8221;yes&#8221; css=&#8221;&#8221;][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text css=&#8221;&#8221;]Septal perforation is a separate and very important chapter of reconstructive septorhinoplasty. A previous operation, an injury, an illness, an infection or substance use can open a hole in the septum that causes crusting, whistling on breathing and bleeding, and that over time sinks the bridge. The aim is to close the perforation and restore or preserve the support of the nose, using cartilage and tissue grafts from the patient. The smaller it is, the easier it is to close: it is worth having it seen early.[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=&#8221;Recovery after surgery&#8221; use_theme_fonts=&#8221;yes&#8221; css=&#8221;&#8221;][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text css=&#8221;&#8221;]Pain on waking is unusual: the discomfort of the first few hours is controlled with oral painkillers. You will wear a <strong>splint on the bridge for a week<\/strong> and, if we have worked on the septum, silicone tubes that let you breathe. Bruising under the eyes is somewhat greater than in a first rhinoplasty, because previously operated bones are being moved; it clears in one to two weeks. Social life after a week, gentle exercise after a month, contact sport after two months. If I took cartilage from the rib you will feel some discomfort in your side for a few days. Swelling in a re-operated nose takes longer to go down than in a primary one: the final profile takes twelve months. Day-by-day care is explained in <a href=\"https:\/\/drmarcoromeo.com\/en\/rhinoplasty-recovery\/\">recovery after nose surgery<\/a>.[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=&#8221;Risks of secondary rhinoplasty&#8221; use_theme_fonts=&#8221;yes&#8221; css=&#8221;&#8221;][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text css=&#8221;&#8221;]They are those of any rhinoplasty: bleeding, infection, bruising and swelling, temporary changes in sensation, some irregularity and the possibility that the result is not what was expected. With a nose that has already been operated on two things have to be added. First, the surgery starts from scarred tissue, less cartilage and skin with less elasticity: the risk of small irregularities and of needing a touch-up is higher than with a nose never operated on, and every further operation increases it. Second, the risks specific to the <strong>rib graft<\/strong>: a scar of a few centimetres on the chest, discomfort at the donor site for a few days and, very rarely, warping of the graft over time; the risk of injuring the pleura is exceptional and is monitored during surgery. What reduces all these risks most is a well-read scan, honest planning and good aftercare. There is always the possibility of minor touch-ups under local anaesthesia or larger ones in theatre.[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=&#8221;When this is not the right surgery&#8221; use_theme_fonts=&#8221;yes&#8221; css=&#8221;&#8221;][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text css=&#8221;&#8221;]<\/p>\n<ul>\n<li><strong>If your nose has never been operated on<\/strong> and what you want to change is its shape: that is a <a href=\"https:\/\/drmarcoromeo.com\/en\/rhinoplasty\/\">rhinoplasty<\/a>, the usual nose operation.<\/li>\n<li><strong>If the problem comes from an injury<\/strong>, not from surgery: that is a <a href=\"https:\/\/drmarcoromeo.com\/en\/post-traumatic-rhinoplasty\/\">post-traumatic rhinoplasty<\/a>.<\/li>\n<li><strong>If you were operated on a few months ago<\/strong> and the nose is still swollen: you have to wait for it to settle before judging the result.<\/li>\n<li><strong>If you only breathe badly, with no deformity:<\/strong> functional surgery may be enough; I explain it in <a href=\"https:\/\/drmarcoromeo.com\/en\/nasal-valve-insufficiency\/\">nasal valve insufficiency<\/a>.<\/li>\n<li><strong>If there is not enough tissue left<\/strong> to rebuild safely: I will tell you in consultation, and sometimes the best decision is not to operate.<\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=&#8221;Secondary rhinoplasty before and after&#8221; use_theme_fonts=&#8221;yes&#8221; css=&#8221;&#8221;][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text css=&#8221;&#8221;]Four cases with a name and a timescale: <a href=\"https:\/\/drmarcoromeo.com\/en\/before-after-cases\/secondary-rhinoplasty-clinical-before-after\/tertiary-rhinoseptoplasty-before-after-case-emg211224\/\">a tertiary septorhinoplasty with a rib graft<\/a>, <a href=\"https:\/\/drmarcoromeo.com\/en\/before-after-cases\/secondary-rhinoplasty-clinical-before-after\/secondary-rhinoplasty-clinical-before-after-case-89050\/\">a structural secondary rhinoplasty with rib cartilage in a man<\/a>, at two months, <a href=\"https:\/\/drmarcoromeo.com\/en\/before-after-cases\/secondary-rhinoplasty-clinical-before-after\/secondary-rhinoplasty-clinical-before-after-case-85100\/\">a drooping tip and an irregular bridge after another rhinoplasty<\/a> and <a href=\"https:\/\/drmarcoromeo.com\/en\/before-after-cases\/secondary-rhinoplasty-clinical-before-after\/secondary-rhinoplasty-clinical-before-after-case-85450\/\">the after-effects of a previous septoplasty<\/a>. All of them are in <a href=\"https:\/\/drmarcoromeo.com\/en\/before-after-cases\/secondary-rhinoplasty-clinical-before-after\/\">my secondary and tertiary rhinoplasty gallery<\/a>; and <a href=\"https:\/\/drmarcoromeo.com\/en\/before-after-cases\/rhinoplasty-clinical-before-after\/rhinoplasty-clinical-before-after-case-ml270623\/\">a nose operated on several times<\/a> with a breathing problem, in the general gallery.[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=&#8221;Revision rhinoplasty in Madrid, Spain&#8221; use_theme_fonts=&#8221;yes&#8221; css=&#8221;&#8221;][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text css=&#8221;&#8221;]I operate in Madrid at <strong>HLA Universitario Moncloa<\/strong> and <strong>Vithas Aravaca<\/strong>. As well as operating, I run an <a href=\"https:\/\/drmarcoromeo.com\/en\/rhinoplasty-7th-intensive-course-in-live-surgery\/\">intensive rhinoplasty course with live surgery<\/a> for other surgeons.<\/p>\n<div class=\"romeo-cta-box\">\n<p>If you had nose surgery and it did not turn out as you expected, or you breathe worse than before, come for a consultation: <strong>the first step is knowing how much tissue is left and what can be rebuilt<\/strong>.<\/p>\n<p><a class=\"btn-romeo-link\" href=\"https:\/\/drmarcoromeo.com\/en\/contact\/\">Book your assessment <span>\u203a<\/span><\/a><\/p>\n<\/div>\n<p>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=&#8221;Frequently asked questions about revision rhinoplasty&#8221; use_theme_fonts=&#8221;yes&#8221; css=&#8221;&#8221;][\/vc_column][\/vc_row][vc_row][vc_column][vc_toggle title=&#8221;How many times can a nose be operated on?&#8221; style=&#8221;rounded_outline&#8221; open=&#8221;true&#8221; css=&#8221;&#8221;]There is no number. Every operation uses up cartilage, skin elasticity and blood supply, and that does not grow back. I have performed fourth and fifth rhinoplasties with a good result and have advised against third ones; it is decided by the tissue that is left, not by the count of operations.[\/vc_toggle][vc_toggle title=&#8221;How long do I have to wait after the first rhinoplasty?&#8221; style=&#8221;rounded_outline&#8221; css=&#8221;&#8221;]Until the nose has finished settling: while there is still swelling from the first operation the result cannot be judged and the revision cannot be planned. I assess it in consultation with the CT scan.[\/vc_toggle][vc_toggle title=&#8221;What is a tertiary rhinoplasty?&#8221; style=&#8221;rounded_outline&#8221; css=&#8221;&#8221;]The third operation on the same nose. It usually needs more grafts than a secondary one, because the septum was already used in the previous operations, and almost always rib cartilage.[\/vc_toggle][vc_toggle title=&#8221;Can I have surgery with you if my first rhinoplasty was done elsewhere?&#8221; style=&#8221;rounded_outline&#8221; css=&#8221;&#8221;]Yes. It makes no difference where the first operation was done or how long ago. It helps to bring the surgical report and photographs from before, but what decides is what I see in the examination and on the CT scan.[\/vc_toggle][vc_toggle title=&#8221;Is it harder than a standard rhinoplasty?&#8221; style=&#8221;rounded_outline&#8221; css=&#8221;&#8221;]Yes. The work is on scarred tissue, with less cartilage and less elastic skin, and it means rebuilding rather than reshaping. That is why planning with a CT scan and experience in reconstruction matter more here than in any other rhinoplasty.[\/vc_toggle][vc_toggle title=&#8221;Is a rib graft always needed?&#8221; style=&#8221;rounded_outline&#8221; css=&#8221;&#8221;]No. If the septum still has enough cartilage, I take it from there. The rib is reserved for noses that lost a lot of structure or whose septum has already been used, and in tertiary cases it is the usual choice.[\/vc_toggle][vc_toggle title=&#8221;How much does revision rhinoplasty cost in Madrid?&#8221; style=&#8221;rounded_outline&#8221; css=&#8221;&#8221;]<strong>Between 9,000 and 19,000 euros.<\/strong> It depends on what has to be rebuilt: the most complex noses need more time in theatre. The price includes the consultation and surgical plan, theatre, team and anaesthesia, follow-up visits and postoperative care. Financing is available up to 10,000 \u20ac. The figures in my <a href=\"https:\/\/drmarcoromeo.com\/en\/plastic-surgery-prices-madrid-guide-dr-romeo\/\">price guide<\/a> are updated for 2026.[\/vc_toggle][vc_toggle title=&#8221;Can a saddle nose be corrected?&#8221; style=&#8221;rounded_outline&#8221; css=&#8221;&#8221;]Yes. It is the typical deformity of a septum that lost its supporting L: the bridge sinks and breathing closes off. The beam is rebuilt with cartilage grafts, almost always from the rib.[\/vc_toggle][\/vc_column][\/vc_row][vc_row][vc_column]<div class=\"gem-icon-with-text gem-icon-with-text-icon-size-medium centered-box gem-icon-with-text-flow\" ><div style=\"margin-bottom:0px;margin-top:0px; \" class=\"gem-icon-with-text-icon\"><div class=\"gem-icon gem-icon-pack-material gem-icon-size-medium  gem-icon-shape-circle \"  style=\"opacity: 1;\"><div class=\"gem-icon-inner\" style=\"background: linear-gradient(to bottom, #40738e, #1c3642);\"><span class=\"gem-icon-half-1\" style=\"color: #ffffff;\"><span class=\"back-angle\">&#xf221;<\/span><\/span><span class=\"gem-icon-half-2\" style=\"color: #ffffff;\"><span class=\"back-angle\">&#xf221;<\/span><\/span><\/div><\/div><\/div><div class=\"gem-icon-with-text-content\" ><div class=\"gem-icon-with-text-text\">[vc_column_text]<\/p>\n<h2 style=\"text-align: center;\">Depends on the case<\/h2>\n<p class=\"aligncenter\" style=\"text-align: center;\"><strong>Procedure duration<\/strong><\/p>\n<p>[\/vc_column_text]<\/div><\/div><div class=\"clearboth\"><\/div><\/div>[\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row content_placement=&#8221;top&#8221;][vc_column][vc_single_image image=&#8221;10589&#8243; img_size=&#8221;full&#8221; css=&#8221;&#8221;][\/vc_column][\/vc_row][vc_row][vc_column][\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=&#8221;What is revision rhinoplasty: secondary and tertiary&#8221; use_theme_fonts=&#8221;yes&#8221; css=&#8221;&#8221;][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text css=&#8221;&#8221;]Secondary rhinoplasty is the surgery that&#8230;<\/p>\n","protected":false},"author":2,"featured_media":10589,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"","_lmt_disable":"","_joinchat":[],"footnotes":""},"class_list":["post-13493","page","type-page","status-publish","has-post-thumbnail"],"_links":{"self":[{"href":"https:\/\/drmarcoromeo.com\/en\/wp-json\/wp\/v2\/pages\/13493","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drmarcoromeo.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/drmarcoromeo.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/drmarcoromeo.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/drmarcoromeo.com\/en\/wp-json\/wp\/v2\/comments?post=13493"}],"version-history":[{"count":0,"href":"https:\/\/drmarcoromeo.com\/en\/wp-json\/wp\/v2\/pages\/13493\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drmarcoromeo.com\/en\/wp-json\/wp\/v2\/media\/10589"}],"wp:attachment":[{"href":"https:\/\/drmarcoromeo.com\/en\/wp-json\/wp\/v2\/media?parent=13493"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}