Secondary Rhinoplasty in Madrid

The experience of surgeon Dr. Sordo, specialist in advanced rhinoplasty

Dr. Gustavo Sordo is a plastic surgeon specializing in advanced rhinoplasty and revision rhinoplasty in Madrid . He received specialized training in secondary rhinoplasty with Dr. Sercan Gode , and has also completed residencies with internationally renowned surgeons such as Nazim Çerkes, Ahmet Alp, and Selim Turam . A member of the Rhinoplasty Society of Europe , he will direct Rhino 360º SECPRE in 2026 and regularly trains residents and plastic surgeons in his operating room to refine their rhinoplasty techniques. His extensive experience allows him to particularly address cases requiring a second procedure, reconstruction, or correction of previous results.

Carving the cartilage is the easy part. The challenge is keeping it alive.

The main risk of a graft is devascularization: that the new tissue doesn't receive enough blood supply to integrate into the nose. Once harvested, the graft has no blood supply of its own; it survives by diffusion for the first few days until the body is able to nourish it. That's why we've developed our own three-stage protocol, specifically designed to maximize the graft's vascular survival. It's not just another surgery: it's a reconstructive project with monitoring at each stage.

Ultrasonic rhinoplasty: maximum precision

In a secondary rhinoplasty, we always work on a bone and cartilage structure that has already been altered, so precision is even more important than in the initial surgery. That's why we reshape the nasal skeleton with an ultrasonic scalpel, instead of using the traditional hammer and chisel: the cuts are much more precise and controlled, with less trauma to the previously treated tissues, less swelling and bruising, and a faster recovery.

When the bone base is wide or has irregularities inherited from previous surgery, we complement ultrasound with the rhinomotor, which allows us to polish and refine the bone surface with a level of detail that conventional instruments cannot offer. The combination of tools we use in all our rhinoplasties is key, and in secondary rhinoplasty, it is especially useful for correcting asymmetries or irregularities left by the first procedure.

Before: we prepare the vascular bed of the nose

• Nanofat injections: We perform an emulsified fat micrograft, rich in stem cells derived from the patient's own adipose tissue, with an anti-inflammatory, angiogenic, and regenerative effect on the damaged vascular tissues of the nose. This prepares the area where the graft will later integrate.
• Botulinum toxin injections at strategic points: They are used to induce vasodilation in the nasal vascular plexus and optimize blood flow to the area.
• Massages, oils and dilators from the date set: The patient performs daily massages of the columella and nasal skin, applies alternating ozone and St. John's wort oils, and wears nasal dilators. The goal is to arrive at the operating room with more elastic and better-perfused skin.

During: the day of the intervention

• We obtain the costal cartilage graft through a minimal incision, closed with laser to minimize scarring.
• From the very beginning, we placed an anesthetic catheter in the donor area of ​​the rib, so that the patient would not feel chest pain during the postoperative period.
• The cartilage is laminated and carved into several pieces, which are fitted and integrated into the nose with millimeter precision, piece by piece, as if assembling a scale model. The assembly is performed using a Piezotome, an ultrasonic scalpel that allows bone and cartilage to be shaped with minimal trauma to the tissues.
• Once the grafts are placed, we apply fibrin-rich plasma (PRF), obtained from the patient's own blood and concentrated in growth factors to increase the biological performance of the graft and accelerate its integration.