Journal archive · Revision and secondary rhinoplasty · Rib, ear and septal grafts · Open versus closed approach · 2026
Closed Approach Rib Revision Rhinoplasty
Göde S, Berber V.
What this paper says
In 700 complex revision rhinoplasties done through a closed (endonasal) approach with rib cartilage, SCHNOS scores improved from 44.2 to 17.8 and 14.2% needed a further revision.
Overview
Revision rhinoplasty is usually done through an open approach. Göde and Berber report a retrospective cohort of 700 revision patients treated between 2022 and 2024 with an "extended closed" approach and costal cartilage reconstruction. Inclusion required at least one prior nasal surgery, a need for rib grafting, and at least six months of follow-up.
Sections of note
- 700 patients, 2022-2024, minimum 6-month follow-up.
- Presenting problems included over-resected dorsum, short nose with contracted skin, septal or retrocolumellar perforation, columellar necrosis, congenital deformity and damage after implant removal.
- Grafting and flap techniques were tailored to the deformity pattern.
- Mean SCHNOS total improved from 44.2 (SD 5.8) to 17.8 (SD 6.2), p < 0.001.
- Overall revision rate 14.2%.
What it means for a patient
- Even severe revision cases needing rib cartilage were managed without an external columellar incision in this series.
- Roughly 1 in 7 patients needed another operation, a reminder that complex revisions carry real re-revision rates.
- The closed approach avoids a visible scar but demands a highly experienced surgeon; results here are from one high-volume centre.
Why this paper matters
At 700 cases it is one of the largest revision-rhinoplasty series published and challenges the assumption that rib revisions need an open approach. Limits: retrospective, single centre, short minimum follow-up, no open-approach comparison group.
Terms
- Closed (endonasal) approach: all incisions inside the nostrils, no external cut.
- Costal cartilage: rib cartilage, the main graft source when the septum is depleted.
- Contracted skin envelope: scarred, shrunken nasal skin that resists re-expansion.
- SCHNOS: a validated nasal outcome questionnaire; lower is better.
Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows. All 1,262 summaries.
From the abstract
“Revision rhinoplasty remains one of the most challenging procedures due to scar tissue, distorted anatomy, and depletion of septal cartilage. Advanced structural and soft-tissue reconstruction strategies are often required in complex revision cases. This study aimed to evaluate the functional and aesthetic outcomes of…”
Excerpt; the full abstract is on PubMed.
Citation
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What the rhinoplasty literature says on this paper's topics, cited line by line to PubMed.
Revision and secondary rhinoplasty
Between 5% and 15% of rhinoplasties are done again, and the published series say the second operation is a different problem from the first: the cartilage is gone, the skin is scarred and less able to survive, and the airway is usually part of the complaint.
Rib, ear and septal grafts
Modern rhinoplasty builds rather than removes, so the operation runs on cartilage: the septum first, then the ear, then the rib, and when none of those will do, a piece of donated rib from a tissue bank.
Open versus closed approach
Whether the surgeon opens the nose through a small incision across the columella or works entirely through the nostrils has been argued in print since 1973, was put on facing pages of Plastic and Reconstructive Surgery by Jack Gunter and Jack Sheen in 1997, and was finally pooled in 2025: across twenty studies and 1,067 patients there is no significant difference in what patients report, in breathing, in complications or in swelling.
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