Secondary/Revision Rhinoplasty in New Hampshire, near Boston, Massachusetts

In my practice, I specialize in the correction of problems that have developed or worsened as a result of previous nasal surgery. I perform secondary rhinoplasty, also commonly called revision rhinoplasty, at my New Hampshire practice, near Boston, Massachusetts, to help patients who have already been through surgery one or more times and are now suffering from reduced airway function or serious cosmetic problems.

The Importance of Airway Function

Patients who have already undergone one or more disappointing operations have figured out that nasal surgery isn’t as simple as it sounds. Ironically, the most common reason for malpractice suits after nasal surgery is a worsening of the ability to breathe through the nose. In my opinion, this should never occur; patients should breathe as well or better than they did before surgery. We have performed airflow measurements in more than 600 consecutive patients over the last eight years (the largest study of this type in the world), some who have never undergone surgery and many who have had multiple prior procedures. All of the patients had nasal airway obstruction before surgery, and 93 percent were able to achieve a normal airway in one operation. The remaining patients had such complicated problems (because of prior injury or surgery) that more than one operation was required.

Secondary Rhinoplasty: Principle and Practice

The principles of “secondary rhinoplasty,” or nasal surgery on a nose that has already been operated on, are very much the same as those in the primary rhinoplasty situation. It is important to consider nasal balance, function, deformities of cartilage and bone, areas that need additional support or reshaping, and to devise a safe plan that satisfies, to the greatest degree possible, the patient’s aesthetic goals.

In practice, secondary (or revision) rhinoplasty, which comprises two-thirds of the nasal operations at my New Hampshire practice, near Boston, Massachusetts, is much more difficult. The nasal septum, which is the prime building material for nasal surgery, has often been partially or completely removed. The cartilage and bone that create nasal shape have already been altered and are scarred or deformed; and the skin has become thicker and less pliable. The airway is often significantly impaired.

Most importantly, the patient has already gone through one or more prior disappointing experiences, has spent money for operations that didn’t achieve what he or she wanted (or has made them worse); and now needs to “start all over again.” In this setting it is critical that patient and surgeon understand each other. I need to diagnose the problem and explain it to the patient, and then devise and explain a surgical plan that is most likely to achieve what the patient wishes.

Often there are several possible surgical solutions, each with a different outcome, some of which will be more complicated than others. Only by discussing each plan with the patient can he or she decide what will be most satisfactory.

Using the Right Materials

Because the nasal septum is often missing, I often must find building materials elsewhere, always from the patient’s own body. There is no substitute for the patient’s own cartilage and bone. Artificial materials, like silicone, are always a bad idea in the nose, particularly the nose that has previously undergone surgery. They rarely provide a lifetime solution, and although they seem like an easier plan at first, in the overwhelming majority of cases they are ultimately doomed to fail. The patient’s nasal graft may come from the cartilage of the ear, from the rib, or from the outer layer of the skull. Which donor sites are best depends upon the problem, the age of the patient, the patient’s wishes, and many other factors.

Secondary rhinoplasty can be just as successful as the primary rhinoplasty, although because the initial problem is worse, there is a higher chance that second operations or minor touchups may be needed to produce the best result. In my practice, the revision rate for patients who undergo secondary rhinoplasty is about 15 percent. This is a higher number than for other surgeons, but it reflects both the expectations of my patient population and my own desire to produce the best possible result.


The consultation fee for Secondary Rhinoplasty is $250.00. Dr. Constantian’s surgical fee for Secondary Rhinoplasty ranges from $7,800.00 to $8,500.00. The surgical fee can be $9,500.00 – $10,500.00 if rib cartilage is needed.

For patients with no insurance (cosmetic/self-pay patients), the Hospital and Anesthesia fees are approximately $3,520.00.

Because Dr. Constantian operates in a hospital setting, the hospital and anesthesia fees are not within his control and may change from time to time. If you would like more information, please call our New Hampshire office

Common Questions about Revision Rhinoplasty

The following are some of the most common questions about secondary and revision rhinoplasty that patients ask at our New Hampshire practice, near Boston, Massachusetts. Dr. Mark Constantian has provided answers in his own words.

“Why can’t all rhinoplasties be accomplished in one operation? Why is there ever a need for a revision?”
“Do you use the closed approach for both primary and secondary rhinoplasty?”
“My nose is too long and droopy, but my surgeons have told me that I ‘make too much scar tissue’. Can anything be done for me?”
“My nose is too short and the nostrils are too visible; what can be done?”
“I had a rhinoplasty 15 years ago. Now the tip is too sharp, the nose is much too turned up, and the nostrils are too visible from the front. Can you do a facelift at the same time?”
“I have had several nasal surgeries, but my nose now looks very surgical and unnatural. I have a lot of sinus problems and my husband says that I now snore. Can you help even after all of these operations?”
“I had an operation to make my nose look smaller but now it seems fatter, rounder, and bigger at the end. The doctors say that I have ‘scar tissue’ under my nasal skin and they can’t help me. Can I be helped?”
“I had nose surgery to make my nose look better, but instead my breathing got worse and my nose looks worse. I have had two operations to fix a ‘deviated septum’ and I still can’t breathe. The doctors say it is all in my head. Am I crazy?”
“What if Dr. Constantian can’t help me at all?”
“I have undergone two prior nasal surgeries. I had an implant put in to give my nose shape, then had the implant taken out because it was too big.  Now most of the support in my nose has disappeared. I have already spent too much money and if I do another surgery, I want it to be successful. Can you advise me on a specialist here in the South, where I live?”
“I have had three previous rhinoplasty operations. I have reservations about undergoing further surgery. I am happy to send photographs or have an initial phone conversation, but after having had phone consultations with other surgeons, I would prefer to meet face to face even though I would be traveling from overseas. Can you send me consultation and hotel information?”
“I would be willing to travel for the procedure, but I could not see you for a consultation. Can you consult via email?”
“I had a rhinoplasty to correct a broken bridge from a previous surgery. Now the tip looks even bigger, fat, and unattractive. The plastic surgeon swears that he reduced it and says that this could be scar tissue. I have heard that steroid shots can be used. Do you have any ideas about what can be done?”
“Can a nose that has been shortened after a rhinoplasty be lengthened? I think a normal nose should only have a glimpse of nostrils from the front; mine now have more than this and they are now a different size and shape. Can anything be done?”
“If things aren’t perfect, how soon can I have a touch-up?”


Consultation fee: $250

Surgical fee: $8,500 to $15,500 ($9,500 to $14,500 or higher if rib cartilage or time-consuming procedures are needed)

Hospital and anesthesia fees (for cosmetic/self-pay patients): Approximately $3,520

Contact Our Practice

If your previous nasal surgery has left you with breathing problems or an unsatisfactory cosmetic appearance and you are considering undergoing secondary (revision) rhinoplasty, please contact our New Hampshire practice, convenient to the Boston, Massachusetts area.

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