Secondary rhinoplasty requires careful assessment beyond patient-reported history, as prior use of Silicone, Gore-Tex, or Medpor implants is often forgotten. Removal of these materials leads to unpredictable nasal framework damage, with dorsal implant removal particularly challenging due to the structural role of the implant and capsule. Evaluating septal mucosal integrity is critical, especially with Medpor, where coverage may be compromised. Infections after PCL mesh use can trigger severe inflammation, complicating reconstruction. The membranous septum’s condition affects nasal tip mobility, and differences between implant-made sellion and bony nasion must be addressed. Additionally, the presence or absence of caudal septal cartilage determines reconstruction difficulty, while cellulitis severity serves as an index for surgical feasibility.