Background <p>Secondary rhinoseptoplasty (RSP) is technically demanding due to scarring, altered anatomy, and limited septal cartilage. Comparative data on technique selection and complications versus primary procedures are sparse.</p> Methods <p>We analyzed 2,536 consecutive RSPs (2010–2020) at a single center (2,067 primary; 469 secondary). Techniques included columellar strut grafts (CSG), tongue-in-groove (TIG), spreader grafts (SG), spreader flaps (SF), extracorporeal septal reconstruction (ESR), and ear cartilage grafting. Major complications were bleeding, infection, septal perforation, midvault collapse, tip ptosis/derotation, and bony edges. Associations were tested with chi-squared (χ²), Phi coefficients, and logistic regression.</p> Results <p>Mean age was 28.1 (primary) and 31.6 years (secondary). Technique use shifted in secondary RSP: SF decreased (35.22% to 13.01%), ESR increased (14.66% to 24.31%), and ear cartilage increased (0.92% to 8.74%); SG predominated (SG: SF 1.4:1 primary vs. 2.8:1 secondary). Secondary cases were strongly associated with greater use of ESR (OR 2.043, <i>p</i> &lt; 0.001), and ear cartilage (OR 4,37, <i>p</i> &lt; 0.001). Overall, 22/2,536 cases (0,87%) required correction for clinically significant tip derotation (6 secondary). Suspension sutures showed a weak association with tip derotation; CSG and TIG showed no association. Midvault collapse was rare (0.64% secondary vs. 0.44% primary; not significant). In secondary cases with ESR (24.31%, <i>n</i> = 114), no septal perforations or surgical bleeding occurred.</p> Conclusions <p>Secondary RSP more often requires ESR and graft-based reconstruction and favors SG over SF, yet major complication rates did not increase. CSG and TIG provided reliable tip support; suspension sutures warrant cautious use. Tailored technique selection enables safe revision RSP despite greater technical complexity.</p> Level of evidence <p>Level III, therapeutic study.</p>