Most Common Rhinoplasty Risks and Complications

Most patients seeking a nose job are good candidates for rhinoplasty surgery; however, you should always review the benefits as well as the risks for any procedure with your surgeon. Rapport with your surgeon may be the most critical component when deciding to proceed with any surgery.  You want to choose a provider you genuinely trust will hear you and be there for you.  Complications are uncommon but they are a possibility with any surgery.  In the unlikely event of an unanticipated event, you will want to have an open line of communication to ensure you get the care you need.  Be sure to do your research before selecting the best surgeon for you.

In general, rhinoplasties are typically complication-free; however, the possible complications of rhinoplasty surgery include but are not limited to the following:

Infection, bleeding, swelling, scarring, numbness, skin discoloration, nasal obstruction, palpable and/or visible irregularities, asymmetries, disappointment with the cosmetic outcome, personality changes and mental difficulties following surgery (even if the operation is otherwise successful), and allergic or other negative reactions to one or more of the substances used in the operation. Highlighted below are some of the most common rhinoplasty risks and complications.

#1. Nosebleeds

The average amount of time that a patient experiences bloody or blood-tinged mucus drainage from their nostrils after this procedure is about 2 days. However, the range of normal is anywhere from one day to a full week. As long as there is not a steady flow of active bleeding from the nose, then continue to use the nasal “drip pad” provided to you at the time of surgery and the drainage will continue to slow and ultimately stop, almost always within one week.

If you experience a steady gushing of active bleeding from the nose, it is imperative you seek medical care immediately; this emergency typically occurs within 24-72 hours of surgery and doesn’t stop within 10 minutes.  Excessive bleeding is very unlikely (approximately 1 to 2 % of patients). Patients with an underlying bleeding condition, who take supplements or medications that thin the blood, or drink alcohol within a week of surgery are at higher risk for post-operative bruising and bleeding. The treatment of post-op bleeding may require nasal packing, visualization by an endoscope to determine the location of the bleed, or cauterization to stop the bleed.

Pre-operatively, I ask my patients to stop taking any dietary supplements and to avoid alcohol for at least a week.  It is also important to speak with the prescribing provider about whether it is okay to stop taking blood thinning medication prior to surgery and for how long this should be discontinued.

#2. Septal Perforation

Your septum is the cartilaginous structure between the two sides of the nose. Rarely (approximately 1 % of patients), an opening will develop in the septum. This can occur several weeks to months after septorhinoplasty surgery. This issue is not medically emergent but may require surgery to repair. If you have a history of nasal trauma or previous nasal surgeries, you will be at a higher risk for developing a septal perforation. Patients with a history of intranasal drug use, or who use intranasal drugs after surgery, are also higher risk for septal perforation.

#3. No improvement or decline in breathing

For those undergoing functional rhinoplasty to improve breathing, 90 to 95% will have a noticeable improvement in their breathing.  However, a small portion (5 to 10%) will not notice any significant improvement;  in rare cases (less than 1%), patients may feel that their breathing has deteriorated.  For cosmetic rhinoplasty patients, those undergoing purely cosmetic surgery are more likely to notice a decline in breathing (about 1%) than those who are also undergoing combination functional and cosmetic rhinoplasty (less than 1%). If this occurs, revision surgery may be needed.

#4. Affected sense of smell and/or taste

Patients should expect to have changes in taste and smell immediately after surgery; taste is connected with smell, and your nose will experience swelling and occasionally even packing that will affect your ability to smell. The likelihood of any long term effect on your smell or taste would be incredibly rare (less than 0.5 %), but some patients do report experiencing a change in the sense of smell and taste that can last 6-12 months or longer after surgery.

#5. Skin discoloration or scarring at the incision site

Patients may experience a reddening of the nostrils and tip of the nose, resulting from compromised blood vessels in their nose. This complication is most commonly seen in patients with a history of nasal trauma, previous nasal surgery, or nasal filler injections. Any time the blood supply to the nose is compromised by a medical procedure or trauma, the vessels weaken and can lead to a purplish hue to the skin. This is extremely rare (less than 0.5%).

Some patients may experience bumpy or discolored scars after surgery. In the postop period, I recommend applying Vaseline or Aquaphor twice daily to the incision line for the first 2 weeks after surgery to encourage optimal healing.  Beginning 2 weeks after surgery, I recommend using a topical silicone gel and silicone sheeting for at least 4 weeks to minimize the visibility of any scars.

#6. The need or desire for revision surgery

Overall, published revision rates for rhinoplasty range from 5% for tip rhinoplasty to 15.5% for complex revision rhinoplasty.   A history of previous nasal operation or fracture, lack of anatomical correction of an underlying nasal or septal deformity, and postoperative complications like infection are all associated with increase revision rates. Failure to optimally address the nasal tip at the time of a primary rhinoplasty has also been associated with a higher level of dissatisfaction after rhinoplasty.

However, in the vast majority of rhinoplasty patients, the desired result is readily achieved. Goal alignment with your surgeon is essential. You want to be sure to select a specialist who routinely performs the surgery you are looking to undergo, and one whose results are similar to the aesthetic you’re looking to achieve. I also recommend patients go home and take time to digest the discussion about surgical technique, post-operative recovery, and altered images. It’s a big decision and I feel it’s important my patients are properly educated and informed to make the decision to undergo surgery.


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