dr manafi / Procedures / Nose / Secondary Rhinoplasty

Secondary Rhinoplasty - Operated nose repair

People with a bad experience of rhinoplasty, who want to undergo it again, usually have great expectations regarding the nose repair. In some cases, no defect may be present in the operated nose, while the person does not think so. Most of these people cannot describe their desired shape for their nose, and are not an appropriate candidate for secondary rhinoplasty.

The other important point is the amount of recovery and whether the patient is satisfied of the result or not.

To assess this issue, it should be noted that whether the description of patient regarding the conditions is realistic and reasonable or not. If the criticism is valid and the patient has reasonable expectations, and with regard to all conditions, he can be a candidate for secondary rhinoplasty.

Patients preoperative photos including family photos which clearly show the patient’s face are also helpful for further evaluation.

The primary surgeon who has operated the patient is not our concern, but if asked sometimes, we prefer to refer the patient to him, provided that he can perform the secondary surgery. It may be asked that which surgeons are eligible for reconstructive surgery; in general, it is said that surgeons learn the procedure in the first 5 years of practice (mastering the techniques of surgery), learn what cases to select in the second 5 years of practice (careful selection of patients), and learn what cases not to select in the third 5 years of practice, the latter shows the surgeon’s professional maturity, after which he can perform reconstructive surgery.

The most difficult secondary patients are those who have too thick or too thin skin in addition to the existing deformity. Deviation in the nose or face makes the task more difficult. The worst case is the presence of multiple incisions on skin, in particular, incisions in alas and nostrils, or damaged and small skin, which sometimes requires repair and provision of skin from forehead or other areas in some of these patients, such as patients who need nasal reconstruction; the necessary explanations are given to patients and their relatives.

Many secondary patients whose noses are too small, have too small and tighten skin as well. These patients often need to massage the skin; acceptably softens the skin after which the secondary rhinoplasty, the necessary cartilage transplantation, and nose fitness can be performed.

Mental and emotional stability of patients in nose cosmetic surgery either primary or secondary is a basic and decisive condition. When you have a patient who correctly identifies the personal problems and knows what he wants, and the physical conditions of the skin, nose, and cartilage are acceptable, the task is clear. But when one person does not know what is wrong and what he wants, the job will be challenging for surgeons.

Frequently Asked Questions

  • The face and around the eyes will swell and bruise in the first two days after operation; this can be reduced by frequent use of crushed ice in a plastic bag with no water leak soaking the dressing and plaster. Ice is not necessary after 48 hours. Swelling and bruises on the face and eyes will resolve within the first two and three weeks after surgery, but nasal swelling may continue for up to six months.
  • Lying with a couple of pillows in the first few days, especially the first two days after surgery, helps the patient. The day after the surgery, the patient can stand and walk with assistance for performing personal needs.
  • Wet and dirty gas in the front of nostrils should be replaced.
  • Drink only cold liquids in the first 48 hours and avoid hard and chewy foods for two weeks.
  • Dressing and plaster that must remain for about ten days to two weeks on the nose should not be wet and moved. Intra-nasal wicks and extra-nasal stitches are removed between the third and seventh days.
  • Avoid talking a lot, scream, laugh, cry, intense chewing, and every action that moves the sign of face and nose for two weeks.
  • Avoid lying on the sides and prone during the first two weeks and if possible during the first two months.
  • Keep the mouth open when sneezing and coughing to avoid pressure into the nose.
  • Take the antibiotics timely and analgesics and multivitamins as ordered. Apply eye antibiotic ointments over the incision line at the base of the nose two or three times a day.
  • Although weak and usually not severe, there is the risk of bleeding from the nose. In case of nosebleed, rest quiet, tilt the head above, and use ice compress.
  • Avoided severe nasal discharge for a month.
  • Use a soft toothbrush from the third day, provided that the upper lip does not move. Light gargle with diluted salt water is recommended to clean the mouth.
  • Do not use glasses for two months; contact lens can be used four or five days after the surgery.
  • Nasal discharge is not drained normally in about a month after the operation, therefore after the removal of the plaster, wet the nose through dropping irrigation saline or diluted salt water and then gently remove nasal discharge near the nostrils with the help of a wet ear cleaner several times a day.
  • Bathing with assistance is permitted four or five days after surgery in the form of washing only the body, not the head. The nose plaster should not be wet and soften by bath steam. After removing the nose plaster, shampooing with a mild shampoo is permitted provided that a manually shower is used with assistance and the nose is not under the flow of water. The nose and face should not be placed under the high-pressure shower up to one month.
  • Nose makeup is permitted after removing the plaster.
  • After removing the plaster, cooking, shopping, and doing personal tasks are permitted provided that the nose is not hit and pressed. Any sport even swimming is forbidden until two months, except walking, and any contact sports such as soccer, volleyball, basketball, wrestling, and martial arts are prohibited for six months.
  • In the first six weeks after surgery, avoid sunlight to the nose; the use of sunscreen is helpful.
  • Avoid excessive reading and tilting of the head in the two to three weeks after surgery, since nasal swelling may increase.
  • Use nasal tape for four to six weeks after surgery; it is very helpful especially in the case of cartilage transplant.
  • The nose is vulnerable in the first three months after surgery. Therefore, avoid hugging children, kissing, and clothing worn from the head.
  • Seriously avoid sexual intercourse up to a month after the operation. The excitement of intercourse may greatly increase the risk of nosebleed.
  • In case of high fever or any unusual problem especially in the first week, call the hospital or your physician.
  • If additional cartilage is given to you in a container with saline and antibiotic, keep it in the freezer; it can be held and used up to five years for possible needs.

  • Taking aspirin or any aspirin-containing medication is prohibited at least 10 days before to three weeks after rhinoplasty and any type of cosmetic and non-cosmetic surgeries. These compounds disrupt blood clotting and may increase the possibility of bleeding. Acetaminophen is a good alternative to aspirin.
  • Let us know if you smoke or have any other habit.
  • Tell us if you suffer from any bleeding disorder or acute and chronic disease, even a welding or colds, especially in the week before surgery.
  • Take a bath the night before surgery and do not makeup and use spicy aroma the day of surgery.
  • Bring all your medical records to the clinic or hospital.
  • Be fasted at the day of surgery (do not drink even water from the morning).
  • Tell us if you are pregnant or breastfeeding.

  • A minimum of 6 months to 1 year should be passed after the previous operation; the minimum time for resolving of nasal swelling.

  • This highly depends on the previous operation. If the septum is not completely consumed by the surgeon in previous operation, there is no need to harvest from other organs; however, if the nasal septum is completely consumed or perforated, the cartilage behind the ear will be the first choice. If it is removed correctly, the beauty of the ear will not be disturbed. The rib cartilage will be the next if more cartilage is required.

  • Those who are dissatisfied with their previous nose surgery, due to breathing difficulty, narrow nostrils, dissatisfaction with appearance of the operated nose, or disproportionateness of the nose with face.
  • Sometimes the operated nose is disproportionate to face. In such cases, doctor Manafi may perform other surgeries instead of rhinoplasty, such as chin and chick surgeries or injections, according to the patient’s face.
  • They should have realistic and reasonable expectations regarding rhinoplasty, and a minimum of 6 months to 1 year is past after their previous operation. 

  • Surgeries requiring anesthesia are associated with some risks, but they can be minimized if the surgeon has more detailed information of the patient’s history, examinations and tests are carried out properly, and the surgery is performed in equipped clinics and hospitals which are approved by the Ministry of Health.

  • The procedure used for rhinoplasty depends on patients, but doctor Manafi uses the open method in most cases. In fact, there is not much difference between open and close procedures and the main difference is in the lowest part of the nose (columella).

  • Rhinoplasty preoperative tests include blood tests (coagulation tests, glucose, urea, etc.) and CT scan, especially when there is a deviated septum.

No. 305, Third floor, Samsung Building (Vanak Bazar), Vanak Square, Tehran


42 99 87 88  (021)


Doctor Manafi’s office hours: 16:30 to 20:30 on even days