Rhinoplasty complications: Potential risks, warning signs and risk reduction

Nose surgery, or rhinoplasty, may be performed to change the shape of the nose, improve breathing, or achieve a combination of the two. Like any other operation, it is not without risk, and the likelihood of complications depends on the individual’s health, nasal anatomy, history of surgery, type of intervention and numerous other factors. It is therefore not possible to specify a single risk percentage or a fixed recovery course for all patients.

A systematic review published in Plastic and Reconstructive Surgery found that a wide range of complications have been reported after rhinoplasty, and that their reported rates vary between studies. The events examined in these studies include the need for further surgery, infection, bleeding, wound dehiscence, nasal septal perforation, breathing impairment requiring correction, and raised scarring. Differences in study design and patient populations mean that figures from a single study should not be treated as a personal prediction for every patient.

The main complications to be aware of

Impairment of, or changes in, nasal breathing

One important aim of assessment before rhinoplasty is to evaluate the nasal airway. In some people, structural problems such as a deviated nasal septum or nasal valve dysfunction may already be present or may need to be addressed as part of surgical planning. The American Academy of Otolaryngology’s clinical practice guideline recommends assessing nasal breathing before surgery and discussing possible changes in breathing after surgery with the patient.

Bleeding, infection and wound-healing problems

Bleeding, infection and impaired wound healing are recognised surgical complications, but their likelihood is not the same for everyone. Medical history, medicines, bleeding disorders, tobacco use and individual circumstances may be important in the preoperative assessment. Patients should not stop or start any medicine or supplement on their own; decisions about medicines before and after surgery should be coordinated with the surgeon and, where necessary, the treating doctor.

Changes in scarring and soft tissue

Tissue healing varies from person to person. Some people may develop more noticeable scarring or soft-tissue changes, or require a longer period of assessment. Judgement of the final surgical result should also take account of that individual’s healing process, rather than follow a fixed timetable for all patients.

The possible need for further surgery

No cosmetic operation can be described as guaranteeing a particular result or guaranteeing that no further intervention will be needed. The rhinoplasty clinical practice guideline emphasises that patients should be informed before surgery about the possibility of needing future surgery.

How can risk be reduced?

• Thorough preoperative assessment: The patient’s motivation and expectations, breathing, coexisting conditions, medicines and surgical history should be assessed.
• Realistic expectations: The goal of surgery should be determined according to the individual’s anatomy, health and needs; the precise result cannot be guaranteed.
• Providing a complete medical history: Concealing an illness, the use of medicines or supplements, or a history of surgery can make safe decision-making more difficult.
• Following the surgeon’s individualised instructions: Postoperative recommendations should be tailored to the type of surgery and the patient’s circumstances; general advice found online should not replace the doctor’s instructions.
• Seeking follow-up if a problem arises: Any severe, worsening or unexpected symptom should be raised with the care team; a complication cannot be diagnosed through an online article.

When should you contact the care team?

If you have a severe, unexpected or worsening symptom after surgery, particularly if it is accompanied by difficulty breathing, significant bleeding, fever or signs of infection, unusual pain, or a marked change in your general condition, you should contact your surgeon or treatment centre in accordance with your discharge instructions. In an emergency, in-person assessment and emergency medical services take priority over online advice.

How complications relate to the type of nose surgery

The risk and treatment plan depend on the type of problem and intervention. For patients with breathing problems and a deviated nasal septum, assessment for simultaneous septoplasty and rhinoplasty may be a topic for discussion. In some patients, preservation rhinoplasty techniques may also be considered according to their anatomy and the surgeon’s assessment; no technique is the best option for everyone.

Frequently asked questions

Can rhinoplasty be described as free of complications?

No. No operation can be regarded as risk-free. Appropriate assessment and planning aim to identify risk factors and reduce preventable risks.

Is the complication rate the same for all patients?

No. Scientific reviews show that reported complication rates vary between studies. Individual risk should be assessed by a doctor on the basis of health, anatomy, the type of surgery and other factors.

Is one rhinoplasty technique always less risky than the others?

The available evidence does not support such a general conclusion for all patients. The technique should be selected according to the main problem, anatomy, treatment goals and the surgeon’s experience.

Reminder: This article is for general education and does not replace an individual medical assessment or your surgeon’s instructions.

Scientific References

1. Sharif-Askary B, et al. Incidence of Postoperative Adverse Events after Rhinoplasty: A Systematic Review. Plast Reconstr Surg. 2020. PMID: 32097305.
2. Ishii LE, et al. Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty. Otolaryngol Head Neck Surg. 2017. PMID: 28145823.