This chapter explores adaptive planning for secondary septorhinoplasty using soft tissue cephalometric analysis (STCA). Secondary cases present unique challenges, including unpredictable nasal damage from prior alloplastic implants like silicone or Medpor, compromised mucosal integrity, and the need to reassess nasal framework stability. Critical factors include evaluating the membranous septum, recognizing differences between the bony nasion and implant-made sellion, and accounting for cellulitis when planning surgery. Through careful case analysis, the chapter emphasizes realistic goals, meticulous preoperative evaluation, and tailored surgical strategies to manage complex deformities and improve patient outcomes.