Revision Rhinoplasty in Sydney: When and Why 05/08/202605/08/2026 by Mel

Revision rhinoplasty (also called secondary rhinoplasty) is surgery to correct or refine the result of a previous nose operation. Approximately 5 to 15 percent of primary rhinoplasty patients eventually consider a revision, most commonly for residual asymmetry, a persistent dorsal hump, tip irregularities, or breathing problems resulting from structural overcorrection. Because the nasal anatomy has already been altered, a revision is harder to perform than the initial operation. It usually runs to 4 to 7 hours, often relies on cartilage grafts taken from the rib or ear, and is generally not advisable until at least 12 months have passed since the original surgery. Dr Peter Laniewski (FRACS, AHPRA MED0001155003) performs revision rhinoplasty at accredited private hospitals in Sydney.

If this sounds like your experience, you are far from the only one, and there are usually ways forward. The sections below walk through what a revision actually involves, why timing matters so much, how surgeons use cartilage grafts, the kind of costs to plan for, and the things worth checking when you choose a surgeon. The aim is simply to help you walk into a consultation with better questions, rather than to suggest any particular result can be guaranteed.

When you are ready to talk through your specific situation, contact our team to arrange a consultation with Dr Laniewski.

What Is Revision Rhinoplasty?

Revision rhinoplasty is nose surgery performed after a prior rhinoplasty. It may be performed to address concerns the patient had hoped the first operation would resolve but did not, to correct a result that has changed over time as healing progressed, or to manage a complication that emerged during recovery.

The word ‘revision’ is more accurate than ‘redo’ because it rarely involves simply repeating the original operation. The anatomy has changed. Tissue has been cut, repositioned and scarred. Cartilage may have been removed or displaced. The surgeon is not starting from the same nasal structure as the original procedure worked with. Each revision is effectively a new surgical problem built on an altered foundation.

Published revision rates across the rhinoplasty literature range from 5 to 15 %, with some sources citing higher rates for technically complex cases. Rhinoplasty is consistently described as one of the most difficult operations in facial plastic surgery, and the possibility of a revision is part of the informed consent process that patients should expect before any primary nose surgery. If you were not told this before your first procedure, it is useful to know it now.

Why Do People Need Revision Rhinoplasty?

The reasons patients seek revision fall into a few broad categories. Understanding which applies to you is part of what Dr Laniewski assesses at consultation.

Persistent cosmetic concerns

These are the most common reasons for revision and can include any of the following:

• Residual dorsal hump. The bump on the nasal profile was reduced but not fully addressed, or the overlying skin has thickened in a way that makes the bridge look less refined than expected.
• Tip asymmetry or irregularity. The nasal tip heals last and reveals its final shape at 12 months or later. Asymmetry, a pinched appearance, or a tip that sits too high or low is sometimes the endpoint of the original surgery rather than a complication of it.
• Over-reduction: saddle nose deformity. If too much dorsal cartilage or bone has been taken away, the bridge can sink inward and leave a dipped or scooped profile. Rebuilding that lost support nearly always calls for cartilage grafting.
• Over-reduction: inverted-V deformity. Excessive reduction of the nasal bones without supporting the upper lateral cartilages can leave a visible V-shaped shadow on the upper part of the nose. Spreader grafts are the standard correction.
• Pollybeak deformity. A beak-like fullness just above the nasal tip, caused either by inadequate reduction of the supratip area or by scar tissue accumulating there during healing. The appearance is of a tip that sits lower than the dorsum.
• Pinched tip. Over-reduction of the lower lateral cartilages narrows the tip but can also narrow the nostrils in a way that looks unnatural and may compromise airflow. Alar batten grafts are the common approach.
• Under-correction. The change made was in the right direction but did not go far enough. This is preferable to over-correction in most surgeons’ view, but it still leaves the patient with an unresolved concern.

Functional concerns

Breathing problems after rhinoplasty are more common than many patients expect. They may include:

• Nasal valve collapse. Taking out too much cartilage can weaken the internal or external nasal valve, so the side wall of the nose draws inward when you breathe in. It is among the more troublesome functional problems that can follow a first rhinoplasty.
• Structural weakening. Removal of excessive septal support can compromise the strength of the nasal bridge or tip, which in turn affects airflow as the structures shift over time.
• Scarring and adhesions. Scar tissue forming inside the nose after surgery can narrow the nasal passage and restrict airflow, sometimes years after the original procedure.

Complications requiring surgical management

A smaller group comes back not for cosmetic reasons but because of a true surgical complication, such as infection around an implant or graft, a septal perforation, lingering swelling from a haematoma that did not resolve, or marked asymmetry where healing was uneven. Each of these is looked at on its own, and the right approach depends on exactly what the problem is and how long ago it started.

How Long Should I Wait Before Revision Rhinoplasty?

Twelve months is the minimum recommended interval between a primary rhinoplasty and any revision. In most cases, 12 to 18 months is the standard that surgeons work to, and it is not a conservative formality. It is based on how nasal tissue actually behaves after surgery.

Swelling settles in two stages. The surface puffiness you can see eases off over the first few weeks. The deeper swelling, the kind sitting in the tip cartilage, the skin over the bridge, and the soft tissue around it, takes far longer and is usually not gone until around the 12 month mark, stretching closer to 18 months if your skin is on the thicker side. In other words, the nose at 6 months is not the nose you end up with at 12. Things that look like real problems at six months, especially a full tip, slight unevenness, or a small bump on the bridge, often sort themselves out as the swelling keeps going down.

Performing revision surgery before 12 months also means operating on immature scar tissue. Fresh post-operative scar is vascular and inflamed. Operating through it increases bleeding, distorts tissue planes, and makes tissue handling significantly more difficult. Waiting allows the scar to mature, which in turn makes the revision safer and more technically predictable.

The exceptions tend to be true functional emergencies: breathing that is badly obstructed and affecting daily life, an infected implant or graft that has to come out, or a septal perforation that is getting larger. Problems like these can warrant acting sooner, and a surgeon will weigh them case by case. For most cosmetic worries, though, waiting really does work in your favour.

Why Is Revision Rhinoplasty More Technically Demanding Than Primary Surgery?

Surgeons who perform rhinoplasty regularly describe revision cases as among the most complex operations they perform. There are four specific reasons for this.

1. The anatomy has been permanently altered. Cartilage that was trimmed, repositioned, or removed during the first procedure is no longer in its original state. The nasal framework the surgeon encounters is not the framework that nature provided. Understanding what was done in the first operation and working with or around those changes requires both surgical experience and careful pre-operative planning.
2. Septal cartilage is often depleted. The nasal septum is the preferred source of cartilage for grafts because it is readily accessible and produces minimal donor-site effect. In many patients who have had a prior rhinoplasty or septoplasty, this source has already been harvested. The revision surgeon must then look to the ear or the rib for graft material, each of which involves a separate surgical site.
3. Soft tissue and skin are more reactive. Every operation leaves behind some inflammation, fibrosis and scarring in the skin and soft tissue over the nose. With each round of surgery the skin grows less forgiving and slower to calm down. Swelling lingers, the tissue is trickier to lift cleanly, and the final shape simply takes longer to show itself.
4. Operative time is significantly longer. A first rhinoplasty that is reasonably straightforward usually runs 2 to 3 hours. A revision more often sits in the 4 to 7 hour range, and where it lands depends on how much needs correcting, whether rib or ear cartilage has to be harvested, and how much rebuilding of the structure is involved.

Cartilage Grafts in Revision Rhinoplasty

Cartilage grafts are used in the large majority of revision rhinoplasty cases. Their purpose is to restore, reinforce, or rebuild the nasal structure that is deficient from the previous operation. The graft material used depends on what is available and what the surgical plan requires.

Source	What it provides	Best suited to	Scar
Nasal septum	Flat, straight cartilage; preferred graft material	Tip grafts, strut grafts, minor dorsal work	None (internal)
Ear (auricular concha)	Curved cartilage; softer than septal or rib	Alar batten grafts, tip grafts, small structural fill	Small incision behind or inside the ear
Rib (costal cartilage)	Abundant, strong; used for significant reconstruction	Dorsal augmentation, major structural rebuilding, saddle nose correction	Small incision at the rib margin (lower chest)

Nasal septal cartilage

Where it is still available, the septum is the first cartilage a surgeon will reach for. It is flat, straight and easy to shape, and taking it leaves no scar you can see. Someone having their first revision who never had a septoplasty during the original rhinoplasty will often still have septal cartilage to use. If the first procedure included a combined septorhinoplasty or a septoplasty, the septal supply may already be used up, in which case another source is needed.

Ear (auricular) cartilage

Cartilage from the bowl of the ear (the concha) is the next most commonly used source. It is harvested through a small incision either behind the ear or inside the ear canal, leaving a scar that is either hidden or barely visible. Auricular cartilage is softer and more curved than septal cartilage, which makes it well-suited to alar batten grafts (which support the side walls of the nose), smaller tip refinements, and areas that benefit from a flexible rather than rigid graft. Both ears may be used if the volume required is greater.

Rib (costal) cartilage

Rib cartilage becomes the preferred graft when a lot of structural rebuilding is needed, for instance correcting a saddle nose, building up the bridge substantially, or restoring tip support after too much was removed the first time. The surgeon takes it through a small cut at the rib margin low on the chest, usually from the 5th, 6th or 7th rib. It is strong and plentiful, and it is really the only source that yields enough volume for major reconstruction.

Rib cartilage grafts do carry specific considerations. The most well-documented is the tendency to warp over time as the cartilage loses moisture after implantation. Surgical techniques to minimise warping, including precise shaping, carving in a balanced manner and using a central core of the rib, are standard practice in experienced hands. The donor site adds a separate, small incision to the procedure and approximately 4 to 6 additional weeks during which heavy lifting and twisting should be avoided.

In some centres, preserved or irradiated cadaveric rib cartilage is used as an alternative to autologous harvest. The use of allograft material in revision rhinoplasty is an active area of clinical practice, and its suitability depends on individual patient factors. Dr Laniewski will discuss graft options with you in the context of your specific surgical plan.

Open vs Closed Rhinoplasty for Revision Cases

Most revisions are done through the open approach, and the logic is simple. Once a previous operation has changed the anatomy, the surgeon really needs to see the structure directly before altering anything. Working through narrow internal incisions on tissue that might be scarred, shifted, or thickened in unexpected ways is harder to do well and less predictable. By lifting the skin and viewing the framework first-hand, the assessment is more accurate, and the plan can be tailored more precisely.

Closed revision rhinoplasty is performed by some surgeons for limited corrections where the structural goals are genuinely contained, and the tissue planes are still navigable. In the Australian context, this remains the minority approach for revision cases. For more on how the open and closed approaches compare in general, see the open vs closed rhinoplasty guide.

Recovery After Revision Rhinoplasty

Recovery from a revision broadly mirrors what happens after a first rhinoplasty: most people are back at a desk job within 1 to 2 weeks, easing into light exercise around 3 to 4 weeks, returning to full activity by 6 weeks, and holding off on contact sport for at least 3 months. For a week-by-week look at the milestones and what to avoid along the way, see the rhinoplasty page.

There are two additional considerations specific to revision surgery. First, post-operative swelling resolves more slowly after a revision than after a primary procedure. The soft tissue is more reactive, has more existing scar, and takes longer to settle. Most revision patients should expect the final result to declare itself at 15 to 18 months rather than 12. Assessing the outcome before that point, particularly at the 6-month mark, is unreliable and often a source of unnecessary distress.

Second, if rib cartilage was harvested as part of the procedure, there is an additional component of donor-site recovery. The chest-wall incision is small, but the area around it can be tender for several weeks. Patients are advised to avoid heavy lifting, trunk rotation, and anything that pulls on the chest wall for roughly the first 4 to 6 weeks. Dr Laniewski’s team will provide specific guidance on donor-site care as part of the post-operative instructions.

Swelling management during revision recovery follows the same principles as primary rhinoplasty: head elevation during sleep, cold compresses to the cheeks in the first 48 hours, and avoidance of bending, straining and nose blowing during the acute phase.

How Much Does Revision Rhinoplasty Cost in Sydney?

Revision rhinoplasty in Sydney typically costs $20,000 to $35,000 or more, depending on the complexity of the required corrections, the length of the procedure, whether a rib or ear cartilage harvest is involved, hospital and theatre fees, and the anaesthetist’s fee. The higher cost compared to primary rhinoplasty reflects the additional operative time, the technical complexity of working with altered anatomy, and the need for cartilage from a second surgical site in many cases.

If there is a documented functional problem, for example, a breathing obstruction that stems from structural changes left by the first operation, Medicare item numbers may cover the functional part of the revision. That said, the Medicare Benefits Schedule narrowed its criteria for revision septoplasty back in November 2018, particularly where the breathing difficulty followed an earlier rhinoplasty done purely for cosmetic reasons. Eligibility for any Medicare contribution is determined at consultation based on clinical assessment, not patient preference, and will be confirmed in writing before you decide to proceed.

Private health insurance may also contribute to hospital admission costs when an applicable Medicare item number is identified. Whether your specific policy and level of cover provide a benefit is best confirmed directly with your fund before booking surgery.

A fully itemised written quote is provided after consultation, once Dr Laniewski has assessed the nose, reviewed any available records from the original surgery, and established a specific surgical plan. An exact fee cannot be provided until this assessment is complete.

How to Choose a Revision Rhinoplasty Surgeon

Choosing the right surgeon for a revision is arguably more important than the choice for primary rhinoplasty, because the margin for further structural compromise is smaller with each successive procedure. There are some specific things to look for.

• FRACS specialist registration. Look for a surgeon who is a Fellow of the Royal Australasian College of Surgeons in Plastic Surgery and holds current AHPRA specialist registration. It is worth checking this for yourself on the AHPRA public register before you book a consultation.
• Regular revision practice. Revision rhinoplasty is a different skill set from primary rhinoplasty. Look for a surgeon who performs revision cases regularly, not occasionally alongside a primarily aesthetic or reconstructive practice.
• Experience with rib and ear cartilage harvest. Most non-trivial revisions require a cartilage graft. A surgeon who does not regularly harvest rib or ear cartilage should not be performing the kinds of revision cases that need it.
• Revision-specific before-and-after results. A portfolio of revision cases looks very different from primary rhinoplasty results. Ask specifically to see revision before-and-afters, not just the full gallery.
• Accredited hospital privileges. Revision rhinoplasty must be performed in a fully accredited private hospital with specialist anaesthetic support. The procedure is too long and too complex for a day procedure facility.
• Willingness to review full surgical history. A thorough revision surgeon will want your original operative notes, any imaging, and a complete account of your recovery before forming a surgical plan. Be cautious of any surgeon who plans a revision without this information.

Having your first rhinoplasty done overseas does not rule out getting revision care here in Sydney. Specialist plastic surgeons in Australia see patients with international cases all the time. The steps are no different: gather whatever operative records the original clinic can give you, bring along any photos that show how your result has changed over time, and come in for a full consultation so the anatomy can be assessed in person.

No surgeon can promise a particular outcome from a revision rhinoplasty. The aim is to improve on the current result rather than to achieve perfection. Dr Laniewski will discuss realistic expectations in detail at the consultation so that you understand both what is achievable and what the procedure itself involves.

How Dr Laniewski Approaches Revision Rhinoplasty

Dr Peter Laniewski is a Specialist Plastic Surgeon (FRACS, AHPRA MED0001155003) and has more than 20 years of surgical experience behind him. His revision rhinoplasty work is carried out in accredited private hospitals at Bella Vista, Woollahra, Erina on the Central Coast, Narellan and Albury.

Every revision assessment begins with a thorough review of the existing nasal structure and a full discussion of the patient’s concerns and goals. Where operative notes and photographs from the original surgery are available, Dr Laniewski will review these before and at the consultation. Photographic documentation is completed at each visit. The NOSE Scale questionnaire is used where there is a functional component to the concern.

Revision rhinoplasty for cosmetic reasons is subject to the full AHPRA cosmetic surgery framework: GP referral, two consultations, body image (BDD) screening, and a minimum 7-day cooling-off period before surgery is booked. Dr Laniewski’s team will also discuss the informed consent process in detail, including the realistic timeline for seeing the final result (15 to 18 months), the role of graft material in the surgical plan, and the possibility that a revision of the revision may still be required, because that is part of accurate informed consent for this category of procedure.

Why Choose Dr Laniewski for Rhinoplasty in Sydney and Central Coast

Dr Peter Laniewski is a Specialist Plastic Surgeon (FRACS, AHPRA MED0001155003) with over 20 years of surgical training and practice across Sydney, the Central Coast and regional New South Wales. He performs both primary and revision rhinoplasty in fully accredited private hospitals and is recognised by Australia’s three peak plastic surgery bodies.

• • FRACS, Specialist Plastic Surgeon. Fellow of the Royal Australasian College of Surgeons. AHPRA registration MED0001155003, verifiable on the public AHPRA register.
  • Member of three peak bodies. Australian Society of Plastic Surgeons (ASPS), Australasian Society of Aesthetic Plastic Surgeons (ASAPS), and Board Certified Plastic Surgeons of Australia.
  • Over 20 years of surgical experience. Undergraduate medicine at the University of New South Wales, advanced training in General Surgery and Plastic and Reconstructive Surgery, and an international fellowship at the Royal Marsden Hospital in London.
  • Sub-specialty training in facial and aesthetic surgery. Further training in Harley Street (London), New York, Germany and France, with a focus on facial and breast aesthetics.
  • Operates in accredited private hospitals. All rhinoplasty and revision rhinoplasty surgery is performed in fully accredited private hospital theatres in Sydney, the Central Coast and Albury, with specialist anaesthetists.
  • Five consultation locations across NSW. Bella Vista (Sydney North-West), Woollahra (Sydney Eastern Suburbs), Erina (Central Coast), Narellan (Sydney South-West), and Albury (regional NSW / Victorian border).
  • AHPRA-compliant cosmetic surgery process. All cosmetic rhinoplasty patients receive a GP referral, two consultations, body image (BDD) screening, and a minimum 7-day cooling-off period before surgery is booked, in line with current AHPRA cosmetic surgery guidelines.

To verify Dr Laniewski’s specialist registration, search ‘Peter Laniewski’ or registration MED0001155003 on theAHPRA Register of Practitioners. To book a revision rhinoplasty consultation, call 1300 322 337 or use the online enquiry form.

Surgeon profile: Dr Peter Laniewski on ASAPS | Dr Peter Laniewski on ASPS | Board Certified Plastic Surgeons of Australia

To book a revision rhinoplasty consultation, call 1300 322 337 or contact us online.

Frequently Asked Questions

How long do I have to wait before having a revision rhinoplasty?

Twelve months is the minimum, and 12 to 18 months is the standard recommended interval. This is because the nose continues to change throughout that period as deeper swelling resolves. Many concerns that are visible at 6 months, particularly tip fullness, minor asymmetry, and bridge shadows, resolve on their own by 12 months. Planning a revision before the nose has fully settled risks operating on a moving target.

Will my insurance cover revision rhinoplasty?

Private health insurance may contribute to hospital costs if a Medicare item number applies to the functional component of your revision. Whether an item number applies depends on the clinical findings at consultation, not on the nature of your first surgery. The cosmetic portion of a revision is not Medicare-eligible. Contact your fund with the relevant item numbers, once they have been confirmed by Dr Laniewski, to understand your specific level of benefit.

Can revision rhinoplasty fix breathing problems caused by my first surgery?

Yes, in many cases. Breathing problems after rhinoplasty are commonly caused by nasal valve compromise, structural weakening, or scar tissue narrowing the nasal passage. Revision surgery to address these issues may involve cartilage grafting to support the nasal valve, spreader grafts to open the internal airway, or removal of obstructive scar. Where the functional problem is significant enough to meet Medicare criteria, a partial rebate may apply. See also the septorhinoplasty page for more detail on combined functional and cosmetic approaches.

How many times can a person have rhinoplasty?

There is no fixed upper limit, but with each successive procedure, the tissues become more scarred, less pliable, and harder to work with. The available structural cartilage may also be progressively depleted. Most experienced surgeons are reluctant to perform more than three to four rhinoplasty procedures on the same patient, and will not proceed if they assess that the tissue condition makes further surgery unlikely to achieve a safe and meaningful improvement. The patient’s overall well-being and psychological state are also part of that assessment.

I had my surgery overseas. Will Dr Laniewski see me?

Yes. Patients who had their original rhinoplasty overseas are seen at consultation in the same way as anyone else seeking revision assessment. Bring whatever records you have from the original clinic, including any photographs of your pre-operative and immediate post-operative appearance. The more information Dr Laniewski has about what was done in the original procedure, the more thorough the revision planning can be.

Is revision rhinoplasty more painful than primary?

Most patients report that revision rhinoplasty is not substantially more painful than their first procedure. Pain after any rhinoplasty is typically described as pressure and congestion rather than sharp pain, and is well-managed with standard pain relief. If rib cartilage was harvested, there is additional tenderness at the donor site in the chest for the first 2 to 3 weeks, which some patients find more noticeable than the nasal discomfort itself. This generally resolves fully within the first month.

Page authored and clinically reviewed by Dr Peter Laniewski, MBBS FRACS, Specialist Plastic Surgeon. AHPRA registration MED0001155003. Last clinically reviewed: 26/6/2026. This page is updated at a minimum every 6 months because cartilage graft techniques and Medicare criteria in this area continue to evolve.

This page is for general information and does not replace a face-to-face consultation. All surgical procedures carry risks. For a personalised assessment, book a consultation with Dr Laniewski.

Further Reading

Rhinoplasty (Nose Job Surgery) Sydney – Dr Laniewski’s complete rhinoplasty procedure page, covering technique, candidacy, costs, and before-and-after results.

Septorhinoplasty Sydney: Combining Cosmetic and Breathing Surgery – A guide to combined functional and cosmetic nose surgery, including Medicare item 41671 eligibility.

Open vs Closed Rhinoplasty: Which Is Right for You? – Explains the difference between the two surgical approaches and how the technique decision is made.

Rhinoplasty Recovery: How to Reduce Swelling After Your Nose Surgery – Practical guidance on managing recovery and swelling after nose surgery.

Medical References

Cochran CS, Gunter JP (2010). Secondary rhinoplasty and the use of autogenous rib cartilage grafts. Clinics in Plastic Surgery 37(2):371-382. PubMed.

Wee JH et al (2015). Complications associated with autologous rib cartilage use in rhinoplasty: a meta-analysis. JAMA Facial Plastic Surgery 17(1):49-55. PubMed.

Australian Health Practitioner Regulation Agency (AHPRA). Cosmetic surgery guidelines (effective 1 July 2023). ahpra.gov.au.

Medicare Benefits Schedule, Item 41671 (Septoplasty). Australian Government Department of Health. MBS Online.

Healthdirect Australia. Rhinoplasty (nose job). healthdirect.gov.au.

Cleveland Clinic. Rhinoplasty (Nose Job): What It Is, Recovery and Results. my.clevelandclinic.org.