What is revision rhinoplasty?
Revision —or secondary— rhinoplasty is the surgery that corrects the result of a previous rhinoplasty, whether performed here or by another surgeon, in Puebla or anywhere else. The usual reasons are aesthetic (a tip that dropped, an irregular or scooped dorsum, a crooked nose, an "operated" look), functional (breathing worse than before the first surgery) or —most frequently— both at once.
And something should be said at the outset, because revision patients often arrive feeling they did something wrong: a rhinoplasty that needs revision does not necessarily mean there was negligence. The nose is the aesthetic organ that behaves worst during healing — living cartilage under skin that contracts for months — and a revision rate exists in the practice of every honest surgeon in the world. What is true is that the second operation is harder than the first.
Why the second is harder than the first
This is the part almost nobody explains, and it decides everything else in the plan:
- There is scar tissue. The anatomical planes that separate cleanly in a virgin nose are now stuck together and fibrotic. Finding and working them without damage takes more time and more care.
- Cartilage is missing. The first surgery removed tissue — sometimes too much. In a revision there is frequently not enough material where there should be, and the surgeon finds less than needed precisely when more is needed.
- Support is weakened. A dropped tip or a collapsed dorsum is almost never fixed by "taking a little more off": it is fixed by giving structure back. Revision rhinoplasty is largely a reconstructive operation, not a resective one.
- The skin no longer behaves the same. It has lost elasticity and its ability to redrape over a new framework is reduced, which limits how much can be changed.
Techniques used by Dr. Arístides Arellano
Planning a revision is longer and more detailed than planning a primary, and its axis is where the missing cartilage will come from:
- Septal cartilage graft: the first choice when septum remains available. It is the most suitable material and the closest at hand.
- Auricular (ear conchal) cartilage graft: the usual source when the septum was already used in the first surgery. It is harvested through a posterior incision that leaves the scar hidden and does not change the shape of the ear.
- Costal (rib) cartilage graft: reserved for major reconstructions, when a dorsum or a support that no longer exists must be rebuilt. It provides abundant, firm material, at the cost of an additional donor site on the chest.
- Structural support grafts: the technical vocabulary of revision — columellar strut, spreader grafts, tip grafts. These are the pieces that restore projection, hold the tip and reopen a collapsed airway.
- Open approach: indicated in most revisions, because it allows direct sight of what was done before and what remains, rather than working blind on an already-modified anatomy.
- Simultaneous functional correction: residual septal deviation or nasal-valve collapse —a frequent reason a patient breathes worse after a first surgery— is corrected in the same operation.
Dr. Arístides Arellano’s track record in nasal surgery
The nose is one of the most constant lines of his training, documented in his credential archive:
- Nasal surgery course (1988) and International course: refinements in rhinoplasty (1988), in Buenos Aires.
- 1st International Course in Facial Plastic Surgery — "The nose" (1990).
- International course “Science and art in rhinology and facial surgery” (1999) and the Mexican Rhinology Society course (1999).
- Recognition from Dr. M. Eugene Tardy Jr. (AAFPRS), 1999 — one of the international reference figures in rhinoplasty.
How is it performed?
Surgery is performed under general anaesthesia in a hospital operating room. It takes longer than a primary rhinoplasty —usually 3 to 4 hours or more, depending on what must be rebuilt— and frequently involves an additional donor site (ear or rib). An external splint is placed at the end and removed at around day seven.
All surgery carries risk and requires a prior medical assessment. Results may vary according to each patient, their anatomy and their individual healing process.
When can I be operated on again?
Almost never immediately, and this is one of the most important conversations at consultation. Waiting at least 12 months from the previous surgery is advised —often longer— before reoperating. The reason is not bureaucratic: during the first year swelling subsides and scar tissue matures, and a nose that looks wrong today can improve considerably on its own. Operating on inflamed tissue and immature scar is operating on a moving target, and it produces worse results.
If you are coming from a recent surgery and are worried, the consultation is still useful: to tell you what is swelling —which will resolve— and what is structure —which will not. Sometimes the most useful answer we can give is wait.
Who is a good candidate?
- At least 12 months elapsed since the previous surgery, barring a specific indication.
- Persistent aesthetic or functional dissatisfaction, now settled and not attributable to residual swelling.
- Good general health and skin in reasonable condition.
- Realistic expectations — more so here than in any other surgery. A revision improves, corrects and rebuilds; it does not always reach the result that a well-planned first surgery would have achieved. A surgeon who promises a revision patient a perfect result is not telling them the truth.
- Willingness to accept an additional donor site (ear or rib) if the case requires it.
Recommended post-surgical treatments
Swelling after a revision is more prolonged than after a primary and the result takes longer to settle. Dr. Arístides may recommend facial manual lymphatic drainage and hyperbaric chamber sessions to support recovery. See the full guide: Post-surgical recovery and care.
Before and after
Most patients want to see before-and-after photographs before deciding. Out of respect for each person’s privacy, Dr. Arístides Arellano shows real cases —always with documented consent— during your in-person consultation, where you can review results from patients with a starting point similar to yours. Results may vary from patient to patient.
Approximate price
Revision rhinoplasty has no catalogue price, and publishing one would be misleading — no two revisions are alike. The cost depends on what must be rebuilt, on whether an ear or rib graft is required (an additional donor site), on the length of the operation and on hospital and anaesthetist fees. It is defined at the consultation, with clear information. For reference, a primary rhinoplasty starts at $45,000 MXN; a revision costs more than a primary, because it is a longer and more complex operation. Approximate price — the definitive cost is set at your private consultation with Dr. Arístides Arellano. See the price list.
About Dr. Arístides Arellano
Dr. Arístides Arellano is a plastic surgeon holding a specialty licence: he practises under a Mexican medical licence (D.G.P. 1125959) and a specialty licence in Plastic & Reconstructive Surgery (0002008), both issued by the Directorate General of Professions (DGP), which reissued his certificate of professional standing in 2025. His career began before Mexico’s present-day specialty-board system existed: he belongs to the founding generation of plastic surgery in Puebla, the second generation of a surgical tradition started in 1971 by Dr. Francisco Arellano Ocampo. Trust is verified, not promised: both licences are public and anyone can look them up in the DGP’s National Registry of Professionals.
Related patient guide
Before deciding whether your result is definitive or still swelling: How long do rhinoplasty results last? A month-by-month timeline — the guide that explains what changes and when, reviewed by Dr. Arístides Arellano.
Recovery · step by step
- Days 1–7External splint, swelling and bruising. Rest with the head elevated. The splint is removed around day 7.
- Weeks 2–3Visible swelling subsides considerably; most patients resume social life.
- Months 1–3The tip remains swollen — more, and for longer, than after a primary rhinoplasty. This is normal.
- Months 6–18The definitive result settles. In a revision this process is LONGER than after a first surgery: patience is required.
Frequently asked questions
How much does revision rhinoplasty cost in Puebla?
Revision rhinoplasty has no catalogue price: no two revisions are alike. The cost depends on what must be rebuilt, on whether an ear or rib cartilage graft is required, on the length of surgery and on hospital and anaesthetist fees. It is defined at the consultation. For reference, a primary rhinoplasty starts at $45,000 MXN, and a revision costs more because it is a longer and more complex operation.
How long should I wait before having my nose operated on again?
Waiting at least 12 months from the previous surgery is advised, often longer. This is not a formality: during the first year swelling subsides and scar tissue matures, and a nose that looks wrong today can improve considerably on its own. Operating on inflamed tissue and immature scar produces worse results. Even so, it is worth attending a consultation beforehand: it distinguishes what is swelling, which will resolve, from what is structure, which will not.
Why is revision rhinoplasty harder than the first operation?
For four reasons. There is scar tissue, and the planes that separate cleanly in a virgin nose are stuck together and fibrotic. Cartilage is missing, because the first surgery removed tissue and sometimes too much. Nasal support is usually weakened, so structure must be given back rather than more taken away. And the skin has lost elasticity, which limits how much can be changed. It is largely a reconstructive operation, not a resective one.
Where does the cartilage come from in a revision rhinoplasty?
The first choice is the patient’s own septal cartilage, if any remains. When it was already used in the first surgery, the usual source is ear (conchal) cartilage, harvested through a posterior incision that leaves the scar hidden and does not change the shape of the ear. In major reconstructions, rib cartilage is used, providing abundant firm material at the cost of a donor site on the chest.
Can revision rhinoplasty fix my breathing?
Frequently yes, and it is one of the most common reasons for consultation. Breathing worse after a first rhinoplasty is usually due to residual septal deviation or nasal-valve collapse, and both are corrected in the same operation, generally by rebuilding support with grafts.
Will I look as though I was never operated on?
Not always, and that deserves to be said plainly. A revision improves, corrects and rebuilds, but it does not always reach the result a well-planned first surgery would have achieved, because it works with less cartilage, more scar and skin with less elasticity. A surgeon who promises a revision patient a perfect result is not telling them the truth. Results may vary.
Does this mean my first surgeon did something wrong?
Not necessarily. The nose is the aesthetic organ that behaves worst during healing: living cartilage under skin that contracts for months, and a revision rate exists in the practice of every honest surgeon in the world. What is true is that the second operation is technically harder than the first.
How long does a revision result take to show?
Longer than a primary. The tip stays swollen for months, and the definitive result can take 12 to 18 months to fully settle. It is the facial surgery that demands the most patience.
Every case is different. Discuss yours in a personal consultation.
Book a consultation on WhatsAppEvery figure published on this site is approximate and is not a quote. Any procedure or treatment first requires a private assessment consultation with Dr. Arístides Arellano —$800 MXN, charged separately— and it is at that consultation that the definitive cost of your case is determined.
Educational content; it does not replace a medical consultation. Results may vary from person to person.