Rhinoplasty risks and complications

Rhinoplasty is a common operation, and most people heal without a serious problem. But it is real surgery, and the nose is both a visible feature and a breathing passage. The risks fall into two groups: those that come with any operation and anaesthetic, and those that belong to the nose. This guide lists what the sources report. It cannot tell you your personal risk. Your surgeon should.

What are the general risks of surgery?

The general risks are those of any operation under anaesthetic. MedlinePlus lists reactions to medicines, breathing problems, bleeding, infection and bruising. ASPS lists anaesthesia risks, infection, poor wound healing or scarring, and skin discoloration and swelling.

Smoking and some medicines raise the risk. MedlinePlus advises stopping blood-thinning medicines using the surgeon’s list, seeing your regular health care provider to confirm that surgery is safe, and stopping smoking at least 2 to 3 weeks before and after surgery.

What are the risks specific to the nose?

These are the risks reported for rhinoplasty itself.

• Breathing problems. ASPS lists difficulty breathing. MedlinePlus lists worsened nasal breathing. StatPearls says nasal obstruction may follow collapse of the internal valve, septal deviation, or grafts that press on the external valve.
• Loss of nose support and contour deformities. MedlinePlus lists both.
• An unsatisfactory appearance. ASPS and Cleveland Clinic list this. ASPS says results may not be completely symmetric.
• Numbness or pain. ASPS lists a change in skin sensation. MedlinePlus says the tip may stay swollen and numb for several months.
• A change in the sense of smell. Cleveland Clinic lists this.
• Small red spots. MedlinePlus says tiny burst blood vessels may leave small red spots that are usually minor but permanent.
• Visible scars. An inside-only approach leaves no visible scars, says MedlinePlus. Narrowing flared nostrils may leave small scars at the base. An open approach leaves a scar across the columella. Cleveland Clinic and StatPearls both note this.
• A hole in the septum (septal perforation). ASPS calls this rare. It says repair may need more surgery and the problem may be impossible to correct.
• Septal haematoma. This is blood collecting in the septum. StatPearls says it should be recognised and drained promptly to prevent infection.
• Alar retraction. The nostril rim is pulled up. StatPearls says it can follow aggressive trimming of the tip cartilage.

How the risks relate to individual noses is covered in the nose-concern guides: dorsal hump, bulbous tip, crooked nose and deviated septum.

How common are infection and bleeding?

Infection is uncommon, and bleeding is usually mild. StatPearls says infections occur in less than 1% of rhinoplasties. A hospital series on revision septorhinoplasty says infection is rare because the nose is well supplied with blood, and lists poor technique, excessive cautery or diabetes as possible causes. StatPearls says bleeding is often mild and usually resolves with head elevation and nasal decongestant sprays.

Signs that need a call to your surgeon include difficulty breathing, nausea or vomiting, fever or yellow discharge, severe pain and uncontrolled nosebleeds, says Cleveland Clinic. See problems after you get home.

How often is a second operation needed?

Estimates for revision run from about 5% to 15%. Cleveland Clinic says about 15% of people need a revision operation. A single-centre study of 732 closed rhinoplasties found a revision rate of 8.6% and cited a literature range of 5 to 15%. A hospital reported 7.5% (32 of 425 patients) had revision septorhinoplasty for complications of earlier surgery over five years. These numbers measure different things, in different hospitals, and are not predictions for your nose.

The 732-patient study found factors linked to revision. A respiratory problem before surgery was the strongest functional factor (adjusted odds ratio 3.30). Wide nasal bones and side walls (3.94), and deviated bones and side walls (2.68) were aesthetic factors. A “pollybeak” fullness above the tip was the most frequent aesthetic reason. Cartilage camouflage grafts at the first operation were linked with a lower revision risk (0.26). It is a retrospective study, so it shows association, not cause, and the authors say the revision rate may be underestimated because follow-up was short.

StatPearls says revision is generally delayed 6 to 12 months so swelling can settle. See revision rhinoplasty.

What affects your risk?

Several factors that you and your surgeon can influence:

• The surgeon’s experience with your type of nose and with revision cases.
• The facility. Hospital or day-hospital setting, anaesthetist present, overnight care and emergency transfer. See hospital, day hospital or clinic.
• Your health history. StatPearls lists prior nasal surgery, sleep apnoea, chronic sinusitis, bleeding disorders and cocaine use as things the surgeon should ask about.
• Expectations and mental health. StatPearls lists body dysmorphic disorder and depression in the assessment, and says patients with psychiatric conditions should be offered surgery only after careful counselling. This is not a reason to hide anything. A good surgeon asks to protect you.
• Following aftercare. Read aftercare once you are home.

What is different about having surgery abroad?

The operation is the same. The follow-up is different. The NHS says safety standards abroad may be lower and overseas clinics may not provide follow-up care to the same standard. ASPS says infection is the most common complication in patients who have surgery abroad, that flights and surgery each carry clot risk, and that local doctors may not know which techniques the original surgeon used, which can make treatment hard. See when can you fly after rhinoplasty and is rhinoplasty in Albania safe?

What should you ask before consenting?

ASPS says your surgeon and staff will explain the risks in detail and you will sign consent forms. Ask for the risks that apply to your nose, in a language you understand. Ask what happens if you need a second operation, and who pays. Ask who you call at night. Use questions to ask a clinic.

Next steps

Read problems after you get home, then is rhinoplasty in Albania safe?