Rhinoplasty risks

Rhinoplasty is a challenging procedure and high level of training and technical expertise is necessary to minimise the risk of complications. If you have concerns about particular complications or would like further information, please discuss them with me.

• Anaesthesia risks
• Bleeding
• Infection
• Scar issues
• Difficulty breathing
• Skin numbness or pain
• Dental numbness
• Skin swelling
• Skin discolouration
• Change or loss of smell
• Runny nose
• Nasal septal perforation
• Unsatisfactory nasal appearance – asymmetry, irregularities
• Brain fluid (CSF) leak

Technical complications

• Bossae
• Pollybeak deformity
• Inverted V deformity
• Rocker deformity
• Dorsal irregularities
• Nasal valve collapse

General risks of surgery

• Allergic reaction to anaesthesia, antiseptics, sutures or dressings.
• Short-term nausea following anaesthesia.
• Painful incision sites.
• Excessive bleeding from the wound.
• Infection of the wound that may require antibiotics or surgical drainage.
• Build-up of blood around the wound that may need to be surgically drained.
• Delayed healing, which is more common in people who smoke.
• Failure of the wound edges to knit together.
• Formation of keloid or hypertrophic scars, which are raised, thick and itchy.

Specific risks of rhinoplasty

• The pain may be severe and ongoing. You might need prescription painkillers for longer than you thought.
• The nose may still feel numb or have altered sensation after bruising and swelling subside.
• The upper front teeth may feel numb but this is usually temporary.
• The nose’s appearance may be unsatisfactory and may require revision surgery.
• The sense of smell may be impaired, or rarely, the sense of smell may be lost or distorted.
• The nose may be slightly swollen for months. In some cases, it may take at least a year before the nose’s final shape is known
• The skin under the eyes may be darkened, but this usually subsides over six to twelve months.
• The underlying support structures of the nose may be weak and cause the nose to flatten. This can be corrected only by surgery.
• An implant (if one was inserted) may extrude into the nose or through the skin.
• The nasal airways may become narrowed, causing difficulty in breathing through the nose. When major changes to the nose are undertaken, there is a risk that nasal breathing may be altered.
• The tiny blood vessels (capillaries) in the skin of the nose may enlarge, leading to a reddened nose. Laser surgery can usually improve this.
• Around one in twenty rhinoplasty patients’ needs further surgery to the nose in order to achieve the desired effect.

Specific risks of septoplasty

• Permanent perforation of the nasal septum
• Septal haematoma or abscess, requiring drainage

Realistic expectations

Results following rhinoplasty vary according to the person’s facial shape, skin thickness, age and shape of their nasal structures such as bone and cartilage. Healthy patients who have realistic expectations of what surgery can achieve make the best candidates for rhinoplasty. Disappointment after the operation may be due to unrealistic expectations of how much improvement can be made. It is important to realise that improvement, not perfection, is the aim of rhinoplasty.

The results of rhinoplasty can be very delayed, often taking 1-2 years for all swelling to resolve and skin to shrink and redrape over the new bone and cartilage shape underneath. This can be a challenging time for both patients and their families as they cannot see the effect of the surgery until this has occurred. For example, a small reduction in a dorsal hump on the nose may initially look even larger when the splint is first removed until the skin has had a chance to contract down.

Cosmetic surgery is sometimes thought to be the answer to life’s problems but a “new nose” is not a guarantee of happiness. These issues can be complex and may require psychological help rather than cosmetic surgery. In some cases, the patient may be satisfied with the results of surgery but their family and friends react negatively. For example, some people may like the original shape of your nose or may feel that you have rejected a family trait. Comments may be hurtful, but it is important to keep in mind your reasons for choosing rhinoplasty. Often the journey is best made without the involvement of overbearing and critical (but usually well meaning) family and friends.