Closed Approach Rib Revision Rhinoplasty.

AIMS AND BACKGROUND: 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 extended closed rib revision rhinoplasty. ANATOMY: Patients presented with severe anatomical distortions, including overresected dorsum, short nose with contracted skin envelope, septal or retrocolumellar perforation, columellar necrosis, congenital deformities, and sequelae of artificial graft removal. PATIENT SELECTION: This retrospective cohort study included 700 revision rhinoplasty patients treated between 2022 and 2024. Inclusion criteria were at least one prior nasal surgery, the need for costal cartilage grafting, and a minimum follow-up of 6 months. TECHNIQUES: All patients underwent extended closed rhinoplasty with costal cartilage reconstruction. Tailored grafting and flap techniques were applied according to deformity patterns. Outcomes were assessed using pre- and postoperative SCHNOS scores, with paired statistical analyses performed (p < 0.05). CONCLUSION AND CLINICAL RELEVANCE: Mean SCHNOS total scores improved significantly from 44.2 ± 5.8 to 17.8 ± 6.2 (p < 0.001). The overall revision rate was 14.2%. Extended closed rib revision rhinoplasty provides a reliable and effective alternative to open approaches in complex revision cases.