Follow-up or multiple operations

As a reference centre for facial surgery at the Kuzbari Centre for Aesthetic Medicine in Vienna, we carry out such corrective operations very frequently.

Four in ten nasal operations at the Kuzbari Centre are revision rhinoplasties on a nose that has already been operated on. Such procedures call for particular experience: the tissue is scarred, cartilage is sometimes missing, and the starting point is different for every patient. We deliberately take on such cases.

What is a follow-up or multiple operation?

A corrective operation, also called a revision rhinoplasty, is a second or third nasal correction that changes the result of an earlier procedure. It addresses deviations in shape, asymmetries, functional problems such as obstructed breathing, or visible irregularities.

Follow-up and multiple operations on the nose are carried out at the Kuzbari Centre by Univ. Doz. Dr. Rafic Kuzbari and Dr. Christoph Grill — two surgeons who have worked intensively with the previously operated nose for years. Thanks to our Vectra 3D simulation you can see beforehand in which direction your nose can change — a decisive step in bringing expectations and possibilities into line.

The most important difference from a first operation is not the technique but the starting point. In an untouched nose the structures lie where the anatomy places them. In a previously operated nose they lie where the first operation left them — and in between there is scar tissue, which behaves differently from healthy tissue. A revision therefore always begins with a careful assessment: what is still there, what is missing, and what can be built from it?

Why patients come to us

The concerns resemble one another, and they almost always have two sides: a physical one and an emotional one. Many describe that their nose no longer suits their face after a previous operation — a tip that has become too pointed, a sunken area on the bridge or a visible edge. Others come because breathing did not improve after the procedure, or even became worse.

Emotionally the strain is often considerable: the daily look in the mirror recalls a decision that did not bring what was hoped for. Insecurity, social withdrawal and the feeling of being alone with the subject are frequent companions. We listen to that before we talk about technique. And we take the time for it: anyone thinking about a nasal operation for the second time needs different answers than the first time — more precise ones, more cautious ones and, above all, more honest ones.

The challenges of corrective operations

Multiple operations are more demanding than first procedures. The anatomy has changed: cartilage and bone may be deformed, tissue scarred or in places no longer present. Scar tissue makes dissection harder, and healing often takes longer because the blood supply has changed.

What we rebuild with

If cartilage is missing it has to be replaced. If the septum still holds enough, we take the material from there — without an additional incision outside the nose. If it is already used up, ear cartilage is an option; for larger reconstructions rib cartilage, which is stable enough to replace load-bearing parts of the framework. Soft contours can additionally be covered with your own fascia so that no edges show through thin skin.

For the nasal tip the same applies as in any other nasal operation, only with less room for manoeuvre: we stabilise it using modern cartilage-supported techniques. This considerably reduces the risk of drooping of the nasal tip over the years. If the nasal bridge is still largely intact, the nose-bridge-preserving technique, known as dorsal preservation, and hybrid techniques can be an option in a revision too — the natural nasal bridge is preserved instead of being removed and rebuilt.

What we can promise and what we cannot

In a revision the achievable result depends more strongly on the starting point than in any first operation. Existing damage has to be addressed first, for instance by removing material, by a scar revision or with tissue grafts from your own body. Some things can be corrected completely, others improved considerably, and in a few places a trace remains.

We tell you this before the operation, on your own images and on the 3D simulation. With a revision an honest expectation is the most important part of the preparation — and the best protection against a third operation.

The right time

The most common mistake with revisions is operating too early. After a rhinoplasty the nose changes over months; the final result shows itself after six to twelve months, with thick skin occasionally only after eighteen. As long as the swelling has not fully subsided, it cannot be judged with certainty what genuinely needs correcting and what is still only swelling.

We therefore usually wait at least twelve months after the previous operation. The tissue has to be healed and soft before it is moved again. Come for a consultation earlier all the same: we look at the course things have taken, put into context what you are seeing, and tell you whether waiting is worthwhile. In rare cases — with clearly obstructed breathing, for instance — an earlier procedure can make sense.

The procedure, step by step

Consultation, planning, operation, inpatient care and aftercare all take place in the same building.

Our expertise and all-round care

At the Kuzbari Centre we combine medical skill with empathy. In a tense situation we listen first and take the frustration seriously. Univ. Doz. Dr. Rafic Kuzbari and Dr. Christoph Grill, our specialists for multiple operations, work with a focus on a natural result and on low risks.

We operate as an inpatient procedure with one overnight stay, including the Kuzbari Safety Check and quality guarantee. Most people are fit to socialise after one to three weeks; after that we accompany you with check-up appointments until the result is settled.

Who takes on revision operations

Whoever advises you also operates on you — and sees you again at the check-ups.

Costs

A revision costs more than a first operation. The reason is the effort involved: scar tissue has to be released, missing cartilage replaced and frequently a graft taken from the ear or a rib. The operating time, too, is usually at the upper end of the range.

An initial consultation with three-dimensional simulation, a technique that suits your nose, and an operating time determined by the findings — this effort is the reason why a rhinoplasty has its price here. It is also the reason why the result is meant to last: a lifetime, not a few years.

Reconstructive nasal surgery · Functional rhinoplasty · Before-and-after cases

Frequently asked questions about follow-up and multiple operations