The nose is the central aesthetic element of the face, and a failed rhinoplasty may lead to significant psychosocial stress and dysfunction. The impact of a failed rhinoplasty should prompt the surgeon to explore the cause of treatment failure and to consider attempting to salvage the outcome with secondary surgery. However, the inexperienced surgeon often exacerbates the initial treatment failure when attempting to correct his or her own work, creating an ever greater challenge for the next surgeon. In such cases, the patient is often apprehensive, skeptical, and mistrusting of further surgery, even at the hands of an accomplished revision rhinoplasty specialist. However, the embarrassment and emotional angst of a failed rhinoplasty eventually prompt further surgery despite the associated fear and anxiety. Yet, in addition to the psychological issues of the revision rhinoplasty patient, the revision surgeon must also contend with the technical challenges of a previously operated nose. Disruption of surgical navigation planes, excessive bleeding, and dense scarring typically make the dissection far more challenging. Moreover, missing, distorted, or damaged skeletal structures typically necessitate complex skeletal grafting, and graft survival is less reliable due to compromised circulation. In the worst-case scenario, vascular insufficiency can lead to graft or skin necrosis. Even when the technical aspects of surgery are successful, postoperative swelling is often increased, and the healing process is usually prolonged. For all of these reasons, a candid and explicit preoperative discussion in which the limitations, risks, and complications of revision rhinoplasty are reviewed in detail must be undertaken. Additional time must also be allotted for a complete discussion of the relevant issues.