Revision Rhinoplasty · Secondary Rhinoplasty
Revision rhinoplasty, when the first isn’t the last.
A revision rhinoplasty corrects problems after a previous nose operation — of the airway, the appearance, or both. Under OHIP a revision is insured only if the original operation was insured and the revision falls inside the recognised period, and acute complications of any operation are insured. Where the revision is cosmetic, fees are quoted in writing after assessment.
Written and reviewed by Dr. Justin Khetani, MD, FRCSC, Otolaryngology–Head and Neck Surgery · Last reviewed
Royal College-certified, Otolaryngology–Head & Neck Surgery, practising in rhinology · Appearance and breathing planned together at one consultation · CPSO register (opens in a new tab)
The Operated Nose
Why a revision is not a repeat of the first.
A nose that has been operated on before is a different surgical problem. Scar tissue has replaced normal planes, the anatomy has been altered, and the septal cartilage a surgeon would normally shape into grafts has often already been used or removed. That is why revision rhinoplasty is more complex than primary surgery, and why the operation is planned from what the nose actually holds — not from what a first-time plan would assume.
Timing matters as much as technique. Revision is usually not considered until the nose has fully settled, commonly around a year after the previous operation: scar tissue softens and swelling resolves over that time, and operating on tissue that is still changing makes both the assessment and the surgery less reliable. Bring any prior operative records you have — what was removed at the first operation matters as much as what is visible now.
Two honest expectations belong up front. Previously operated tissue tends to heal more slowly, so a revised nose can take a year or longer to show its settled shape. And in a large published series, a nose that has already been revised carried a higher likelihood of needing further surgery than a nose operated on once — which is why candidacy is assessed carefully, case by case.
The Structural Work
Rebuilding support, not reshaping.
Much of revision surgery is not reshaping but rebuilding: deformity after a previous rhinoplasty frequently reflects cartilage support that was removed — often as an intended part of the original operation — or has weakened since, and restoring that support usually means grafts. Where the graft comes from depends on what the nose still has.
The septum
The first place to look — and after a previous operation, often no longer available. How much remains is established by examination and, where indicated, endoscopy.
The ear
Flexible cartilage from the ear. Its curve and spring suit camouflage work and moderate support.
The rib
A large, firm supply, used when the framework needs substantial rebuilding. Rib cartilage has a recognised tendency to warp over time, and that trade-off is weighed openly in planning.
A previous operation that reduced or weakened the sidewall cartilage is a recognised cause of nasal valve collapse — a frequent contributor to blocked breathing after rhinoplasty. How the valve is assessed and supported.
The Ontario Rules
Two streams, settled on paper.
-
Assessment
Airway and appearance are examined together, with endoscopy where indicated, and the operative record from the previous surgery is read where one exists. What was removed then decides what can be rebuilt now.
-
The funding question
A revision can sit in either stream. Where one operation addresses both breathing and appearance, the insured and uninsured parts are identified separately, in writing, before anything is decided.
-
Pre-approval where it applies
Where the plan is a septorhinoplasty, the rhinoplasty part needs written approval from the Ministry of Health — the same written application as a first operation. How pre-approval works, step by step.
-
On paper, first
Both outcomes are put in front of you: what belongs to the insured stream, and what a private revision would involve — fees are quoted in writing after assessment.
The revision rule
Revision of surgery performed to alter appearance is an insured service only where the original operation was an insured service, and where the revision either is part of a pre-planned staged process or occurs within a reasonable period of convalescence.
The period
The Schedule reads “reasonable period of convalescence” as two years, with independent consideration given to questionable cases — a guideline with judgement in it.
Complications
Treatment of acute medical or surgical complications resulting from surgery for alteration of appearance or function is an insured service whether or not the original surgery was covered by the Ministry of Health, with no prior authorization required.
If the revision is cosmetic
A revision sought for appearance outside those conditions is not an insured service; fees are quoted in writing after assessment.
- Coverage
- Only if the original operation was insured and the revision falls inside the recognised period. Acute complications of any operation are insured.
- Referral
- Required for the insured stream; not required for a cosmetic consultation.
Common Questions
Revision rhinoplasty, answered plainly.
Only if the original operation was insured and the revision falls inside the recognised period — the same rule the coverage page states. Acute complications of any operation are insured. A revision sought for appearance outside those conditions is not an insured service, and fees are quoted in writing after assessment. Which applies to you is established at consultation, and the insured and uninsured parts are identified separately, in writing, before anything is decided.
Revision is usually not considered until the nose has fully settled, commonly around a year after the previous operation. Scar tissue softens and swelling resolves over that time, and operating on tissue that is still changing makes both the assessment and the surgery less reliable. The wait is anatomical, not administrative — a nose that still changes month to month has not finished healing.
From the septum where enough remains — and after a previous operation it often does not. The next sources are the ear, whose flexible cartilage suits camouflage and moderate support, and the rib, which offers a large, firm supply for substantial rebuilding but has a recognised tendency to warp. Which source your plan would need is part of what is discussed openly at consultation.
Often the airway is the reason a revision is sought at all. Previous surgery that reduced or weakened the sidewall cartilage is a recognised cause of nasal valve collapse, and it is assessed the same way as any valve problem: examination of the sidewall on breathing in, with endoscopy where indicated. Where breathing and appearance are addressed in one operation, the breathing component may be insured; the rhinoplasty component needs Ministry pre-approval.
Assessment first. Then the options are yours.
An OHIP-insured assessment begins with a referral from your physician or nurse practitioner. The office contacts you once it is received. Where the revision sought is cosmetic, consultations are requested directly.