Why is a revision (secondary) rhinoplasty so much more difficult than a first-time (primary) rhinoplasty?
Many reasons. First, after any surgery, scar formation creates a thick, tough layer that is more difficult to work with than original tissue. Second, the original location of (anatomical) landmarks have been altered. Third, cartilage needed to reshape the nose, which was available for use during a primary rhinoplasty, is no longer available to the surgeon performing revision rhinoplasty. Cartilage grafts borrowed from the ear or other parts of the body (as previously discussed) require a second incision. If artificial material is used in revision rhinoplasty, experience selecting and working with artificial material requires advanced skill level. Fourth, the overall skill level required to perform a successful revision rhinoplasty is greater. Revision rhinoplasty has humbled even the most experienced facial plastic surgeon.
