Sinking of the back
The back "collapses", the nose looks saddle-shaped.
Saddle nose
CONDITION / CARRY
Deformation of the nose after rhinoplasty.
Deformation of the nose after rhinoplasty is a persistent change in the shape or breathing of the nose that remains after healing. It is often corrected by repeated (revision) rhinoplasty, but not before the swelling has subsided.
CONCEPTUAL VISUALIZATION- what is it
- A change in the shape or breathing of the nose, which remains after healing and does not go away on its own.
- How often
- Repeat operation was performed in 3.1% of patients after the first rhinoplasty and 11.0% — after the second (175,842 patients, USA, follow-up from 3 years).
- When to fix
- Planned - usually no earlier than a year: during this time, almost all swelling disappears and the form stabilizes.
- Who treats
- A plastic surgeon who performs repeated and reconstructive operations on the nose.
01 / WHAT IS ITWhat is
What is
deformation of the nose.
Deformation of the nose after rhinoplasty is a persistent change in the shape or patency of the nose that remains after the swelling has subsided. This can be a depression or unevenness of the back, asymmetry of the tip and nostrils, or difficult breathing.
Complaints are mostly of two types - appearance and breathing, and often they are combined. Among patients who underwent reoperation, almost two-thirds had problems with form and breathing together.
Such changes are corrected by repeated or revision rhinoplasty. It is more complicated than the first one: the surgeon works with scar tissue and often restores the support of the nose with his the patient's own cartilage.
This is general information. The doctor will tell you after the examination whether you need an operation.
02 / SIGNSHow is
How is
deformation manifested.
Among 100 patients who came for a repeat rhinoplasty, the most common complaints were difficulty breathing (65%), asymmetry of the back (33%) and nostrils (18%).
Asymmetry and inequalities
The tip or back is displaced, tubercles or edges of the cartilage are visible.
"Parrot Beak"
Excess tissue above the tip, the profile looks convex.
Difficulty breathing
The nose breathes worse than before the operation, in one or both halves.
Distortion of the septumNasal valve collapse
The side wall of the nose retracts during inhalation.
Perforation of the septum
Hole in the septum: whistling during breathing, crusting, bleeding.
Perforation of the septum03 / REASONSWhy does this
Why does this
happen.
The nose heals in months, and the result depends both on the technique and on the characteristics of the tissues.
Weakened support
If more cartilage or bone is removed than the frame can withstand, the back will sink over time and the tip will lose its shape.
The middle part of the nose
Short nasal bones, long and weak upper lateral cartilages, thin skin, previous injuries or surgeries increase the risk of problems here.
Scarring
Scar tissue tightens the skin and cartilage unevenly, so the shape can change throughout the year.
Partition not fixed
If the septal curvature remains, breathing may not improve after surgery.
04 / SEEK MEDICAL ADVICE
Wait or apply now?
After rhinoplasty, the nose is swollen for a long time: according to 3D measurements, about two-thirds of the swelling disappears in the first month, 95% in half a year, and 97.5% in a year. Therefore, in the first months, the form is evaluated carefully. But some signs require immediate attention.
103 immediately if:
- bleeding does not stop after 15 minutes of pressing;
- shortness of breath or chest pain;
- high fever with rash, vomiting, or dizziness, especially with tampons or nasal splints.
To the surgeon on the same day, if:
Temperature 38°C and above, pus, increasing pain or swelling, or increasing congestion with pain and swelling of the septum. If the operation was a long time ago and you are worried about your form or breathing, make an appointment for a scheduled consultation.
05 / DIAGNOSTICSHow to determine
How to determine
what to fix.
- Conversation and documents
When and what kind of operation was done, which is troubling; a description of the previous operation, if any.
- Review and photo
Assessment of form, skin and cartilage, photos in standard angles.
- Nasal endoscopy
Inspection of the septum, valves and nasal passages with a thin camera.
- CT scan if necessary
If you need to evaluate bones, sinuses or cartilage stock.
06 / TREATMENTHow to correct
How to correct
deformation.
After the first rhinoplasty, the need for repeat surgery varies: in a review of 36 studies, it ranges from 0 to 10.9%.
01
Restoring the support of the nose
The main thing in a repeat operation is not to take away the excess, but to rebuild the frame.
- Spacer grafts
- Strips of cartilage along the septum widen and straighten the middle part of the nose. Problems in this particular area are among the most frequent reasons for repeated appeals.
- Own cartilage
- First, the cartilage of the septum is taken; if there is none left - from the ear or rib. In a meta-analysis of 20 studies (1648 patients), costal cartilage was distorted in 3.05% of cases, reoperation was required in 2.25%.
02
Breathing and soft tissues
- Correction of the partition and valves
- During the same operation, the septum is straightened and the valves are strengthened to improve breathing.
- "Parrot Beak"
- Excess tissue above the tip. Ways to prevent it and treat it without surgery have been described, but their effectiveness remains debatable. The method of treatment is chosen after an examination, depending on whether the cause is in soft tissues or cartilage.
03
What to expect
- A more complicated operation
- Repeat operations often require complex techniques and extra-nasal cartilage. Another operation after revision was needed in 23.9% versus 10.5% after the first (245 patients of one clinic).
07 / AT THE VALIKHNOVSKY CLINIC
How do we
How do we
treat it.
Deformation of the nose after rhinoplasty at Dr. Valikhnovsky's Institute of Surgery is treated in the "New Nose" direction - along with nose reconstruction after injuries, burns, and tumor removal.
DIRECTION TO THE CLINIC
A new nose
Shape, support and breathing of the nose: septum, concha, sinuses, consequences of injuries, failed operations and removal of tumors.
Go to direction
What do we do in this condition
- Secondary and tertiary rhinoplasty — reconstruction of the frame with the patient's own cartilage from the ear or rib.
- Endoscopic septoplasty — alignment of the partition under camera control.
- PDS plates — absorbable support for partition fragments.
- Piezo instruments — for delicate modeling of the bony part of the back.
- Silicone splints with air ducts — instead of tampons, to partially breathe through the nose after surgery.
Rostislav Valikhnovsky
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovsky Institute of Surgery.
Publications by topic
How is the treatment in us
- Photo and description onlineSend a photo and description of the previous operation - the doctor will assess the situation in advance.
- ConsultationExamination, endoscopy, photo; if necessary — CT.
- PlanWhat to restore and where to get cartilage. If less than a year has passed since the operation, it is often advised to wait until the swelling subsides.
- OperationRepeated rhinoplasty with restoration of nasal support.
- RecoveryThe first weeks — a splint on the back and swelling; the final form is formed in about a year, after repeated operations - sometimes longer.
08 / QUESTIONS AND ANSWERSFrequently asked
Frequently asked
questions.
Short answers. What is right for you, the doctor will tell you during the consultation.
How long after rhinoplasty can you do a repeat?
Surgeons usually advise waiting about a year. According to 3D measurements (40 patients after the first rhinoplasty), 95% of the swelling disappears in half a year, and 97.5% - in a year, so it is difficult to assess the final shape earlier. Complications such as bleeding or infection are treated immediately.
How often is a repeat rhinoplasty required?
In a large study (175,842 patients), 3.1% of patients underwent a repeat operation after the first rhinoplasty and 11.0% - after a second one. In a review of 36 studies, the need for revision ranged from 0 to 10.9%.
Where is the cartilage taken for re-operation?
First - from the septum of the nose, if it remains there; otherwise - from the ear or rib. Own cartilage.
Is it possible to correct the nose if the first operation was done in another clinic?
Yes. A description of the previous surgery is desirable, but the plan is based on the examination, endoscopy and, if necessary, CT.
Can I need another operation after a recurrence?
Yes, the risk is higher than after the first one: in one study, another operation was needed in 23.9% after the second versus 10.5% after the primary.
What is a "parrot beak"?
Excess tissue above the tip of the nose after rhinoplasty, which causes the profile to appear convex. Its cause is soft tissues or cartilage; treatment is chosen after examination.
Sources
9 sources · reviews, meta-analyses, studies and author articleShowCollapse
- Revision Rates and Risk Factors of 175 842 Patients Undergoing SeptorhinoplastyJAMA Facial Plastic Surgery, 2016doi:10.1001/jamafacial.2015.2194 ↗
- Incidence of Postoperative Adverse Events after Rhinoplasty: A Systematic ReviewPlastic and Reconstructive Surgery, 2020doi:10.1097/PRS.0000000000006561 ↗
- Frequency of the preoperative flaws and commonly required maneuvers to correct them: a guide to reducing the revision rhinoplasty ratePlastic and Reconstructive Surgery, 2013doi:10.1097/PRS.0b013e3182a01457 ↗
- Differences between Primary and Revision Rhinoplasty: Indications, Techniques, Grafts, and OutcomesPlastic and Reconstructive Surgery, 2021doi:10.1097/PRS.0000000000008216 ↗
- Spreader Grafts in Functional RhinoplastyFacial Plastic Surgery, 2016doi:10.1055/s-0035-1570127 ↗
- Complications Associated with Autologous Costal Cartilage Used in Rhinoplasty: An Updated Meta-AnalysisAesthetic Plastic Surgery, 2023doi:10.1007/s00266-022-03075-3 ↗
- Prevention and non-surgical treatment of soft tissue polly beak deformity after rhinoplasty: a scoping reviewJournal of Cranio-Maxillofacial Surgery, 2023doi:10.1016/j.jcms.2023.02.002 ↗
- Postoperative Edema Resolution following Rhinoplasty: A Three-Dimensional Morphometric AssessmentPlastic and Reconstructive Surgery, 2016doi:10.1097/PRS.0000000000002760 ↗
- Features of surgical tactics in the reconstruction of the nasal dorsum (Features of surgical tactics in the reconstruction of the nasal dorsum)Clinical Anatomy and Operative Surgery, 2025doi:10.24061/1727-0847.24.3.2025.38 ↗
The figures on the page are from these sources.
Your case
deserves attention.
Describe what operation and when it was done, and what worries you. The doctor will tell if a repeat operation is necessary - or if it is worth waiting.