Like most surgeries, revision rhinoplasty is both a science and an art. Consistent success in revision rhinoplasty requires well-developed judgment, wisdom, and accumulated knowledge and experience. The revision surgeon must have a detailed understanding of the multiple anatomic variants encountered. The surgeon must also have accumulated the appropriate surgical techniques and experience. Specifically, the revision surgeon must acquire knowledge of the surgical alterations that occur and how to achieve an improvement or correction when the result is undesirable. These skill sets are strengthened and refined by careful follow-up of operated patients over time.

The nationally reported revision rate for primary rhinoplasty ranges from 8 to 15%.1–8 Sadly, there will likely never be a shortage of patients requiring revision rhinoplasty. Experienced revision surgeons consistently achieve a high level of satisfaction among their patients. Still, complications can occur despite technically wellperformed surgery. All surgeons have complications. Revision surgery is different from primary surgery.

The tissue planes have often been obliterated, precious tissue overresected and/or asymmetrically resected, and healing forces have distorted weak or weakened cartilages.The elasticity and quality of the skin–soft tissue envelope is a critical limiting factor in revision surgery and must be factored into the surgical plan. Also, the revision surgeon must undertake a careful analysis of the existing cartilage and bony structure. This requires analysis of the existing structure and a mental reconstruction of the patient’s "normal" preoperative anatomy.

A detailed discourse of problems encountered in the revision patient and various approaches to treatment of these problems will be found in this issue of Facial Plastic Surgery and also in a recent textbook.9 For this article, the senior author was asked to select five surgical techniques, ‘‘pearls’’ from my revision rhinoplasty practice that I believe warrant highlighting. Whereas this is far from being an exhaustive list of techniques, it is our hope that this information will be useful to the reader and will stimulate the reader to further study.