Question 1

Why I use the endonasal technique for revision rhinoplasty

Accepted Answer

I perform all nasal corrections using the minimally - invasive endonasal approach, which offers decisive advantages—especially in previously operated noses.
A key benefit is the ability to preserve the delicate connective tissue structures of the nasal tip and infratip lobule, which are often scarred following prior surgery. In many revision cases, the nasal tip must be advanced forward, creating tension along the nasal columella. With the endonasal technique, tension on a newly sutured incision on the columellar skin can be avoided, thus eliminating the risk of visible scarring and wound dehiscence.
Overall, tissue trauma caused by dissection is reduced, and the need for graft material is often lower compared to open techniques.

Question 2

Who performs your nasal surgery?

Accepted Answer

I perform your surgery personally. This is a central element of my quality commitment. I am available to you before, during, and after your procedure.
As part of my center’s educational mission, I train experienced, board-certified colleagues (fellows) who spend approximately one year observing and assisting in highly specialized procedures. However, the actual surgical performance is always carried out by me.

Question 3

Avoidance of nasal packing

Accepted Answer

I do not use nasal packing. In most cases, patients can breathe through their nose immediately upon awakening from anesthesia.
Swelling and bruising are reduced by the minimally – invasive endonasal technique. Many patients already appear socially inconspicuous at the time of splint removal after approximately 10 days. Postoperative taping to reduce swelling is usually unnecessary.
The procedure is performed on an outpatient basis, without an external incision on the nasal columella and without lifting the skin of the nasal tip. All sutures are self-dissolving.

Question 4

Revision rhinoplasty in cleft patients

Accepted Answer

Children born with cleft lip and palate can usually be treated successfully in multiple surgical stages during early childhood, with priority given to speech and swallowing function and closure of the lip and palate cleft. In early adulthood, nasal appearance becomes increasingly important.
I perform a relatively high volume of cleft nose rhinoplasties, including complex and previously operated cases. For effective correction, I developed a specialized method that has since been adopted by other major centers. Using the “foundation graft” technique, the nasal base on the cleft side can be elevated and symmetrized. Examples can be found in the “Before and After Photos” section.
Endonasal correction of cleft nose deformities is typically performed in adulthood from the age of 17 years onward. I do not recommend performing rhinoplasty earlier than 17 years of age.
Cleft formation significantly affects nasal development, often leading to narrowing of the nostril on the cleft side, deviation of the nasal septum toward the opposite side, flattening and distortion of the nasal tip, and deformities of the nasal base.
Correction should be performed after completion of pubertal growth to prevent further deformities caused by growth disturbances.
Cleft nose surgery is considered particularly demanding. Correction of asymmetry of the skin–soft tissue envelope is challenging, as is reconstruction of the cartilaginous framework. In many cases, minimally invasive, endoscopically assisted rib cartilage harvesting via a small incision in the lower lateral chest wall is required.
In highly complex cases, a two-stage surgical approach may be necessary. Treatment planning is carried out in close consultation with you and tailored precisely to your individual anatomy. Often, correction of the lip scar can be performed during the same operation.
The endonasal approach offers major advantages: no tension-bearing incision on the nasal columella, usually no need for nasal packing, and a nasal splint worn for approximately 10 days. Most patients are socially presentable again after 10–14 days.

Question 5

Harvesting ear or rib cartilage

Accepted Answer

In revision surgery, additional cartilage grafts may be required. Cartilage can be harvested either:

Through an incision hidden in the fold behind the ear, or
From a rib via a small incision in the chest wall

I take great care to harvest ear cartilage in a way that preserves the natural shape of the ear. A light dressing is usually removed on the first postoperative day, and the ear typically appears inconspicuous shortly thereafter.
Rib cartilage harvesting is performed using a minimally invasive, endoscopically assisted technique, significantly reducing postoperative pain. Most patients require pain medication for only 2–4 days after rib cartilage harvesting. Most frequently, an incision is placed over the lower side of the chest on the right.

Question 6

Before-and-after photos – Revision Rhinoplasty

Accepted Answer

Before-and-after photos are particularly valuable for patients considering revision rhinoplasty. Results of reconstructive nasal surgery are shown in the “Before and After Photos” section.
Due to current legal regulations in Germany, comparative images of cosmetic nasal surgery may not be publicly displayed online. We fully respect these regulations, which serve to protect patient privacy.
If you wish to view results of cosmetic nasal surgery, please email This email address is being protected from spambots. You need JavaScript enabled to view it. with your name, age, gender, and a brief description of your specific treatment interest. We will respond individually. By submitting your data electronically, you consent to electronic communication and acknowledge that data transmission in both directions occurs at your own risk.

Question 7

Non-binding preliminary assessment

Accepted Answer

If you send us photographs of your nose, I will be happy to provide a non-binding preliminary assessment of the procedure and estimated costs.
Photographs should be taken against a neutral background, from approximately 2 meters distance, from the front and side, with face and neck filling most of the frame. Please send them to praxisteam.gassner (at) gmail.com, including your name, gender, date of birth, address, and treatment request.
I respond personally. By submitting your data electronically, you consent to electronic communication and acknowledge that data transmission in both directions occurs at your own risk.

Question 8

Expertise in Revision Rhinoplasty

Accepted Answer

Internationally recognized expert in endonasal rhinoplasty
Ranked No. 1 in Germany on the Jameda patient portal for “Rhinoplasty” (2024)
Invited speaker on nasal surgery at leading international congresses
Regular live demonstrations of endonasal surgical techniques at operative courses
Director of “The European Course in minimally invasive and Endonasal Rhinoplasty”, one of the largest European surgical courses in nasal surgery
Widely cited scientific publications and book chapters on rhinoplasty
Over 4,000 endonasal rhinoplasty procedures performed over more than 20 years
Approximately 40% complex external revisions / secondary procedures
Treatment of prominent patients, nationally and internationally

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Treatments / Revision Rhinoplasty

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Revision Rhinoplasty

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