Failure of primary functional endoscopic sinus surgery (FESS) may be attributable to systemic disease, anatomical abnormalities, lack of an appropriate surgical technique, and insufficient postoperative care. Residual air cells and maxillary ostial stenosis are the most common primary contributors to FESS failure in cases of revision endoscopic sinus surgery (RESS); most patients who undergo RESS present with residual lesions in the maxillary, ethmoid, and sphenoid sinuses. The RESS procedure is similar to that used for primary FESS. However, RESS is technically more challenging owing to unavailability of anatomical landmarks, a high risk of bleeding, development of adhesions, and lesser surgical experience in RESS compared with primary FESS. The residual middle turbinate, sphenoid sinus opening, orbital wall, and skull base are used as anatomical landmarks during RESS. In addition to these landmarks, image guidance systems are used for intraoperative identification of anatomical structures, particularly during RESS. In patients in whom RESS is performed for treatment of mucopurulent rhinorrhea and nasal polyps, mucopurulent rhinorrhea tends to show significant improvement postoperatively. Posterior nasal drip is the most common residual symptom observed after RESS. In addition to the implementation of the appropriate surgical technique, active postoperative care is essential to reduce the failure rate of RESS. The incidence of RESS-induced complications ranges from 1.1% to 12.5%. Thorough understanding of sinus anatomy, proficiency in surgical techniques, and careful pre- and intraoperative preparation are important to reduce RESS-induced complications. Image guidance is also useful to minimize complications associated with difficult RESS.