Whether performed for aesthetic reasons or functional improvements, such as correcting a deviated septum, the rhinoplasty procedure carries inherent risks.
While advancements in surgical techniques have improved safety and outcomes, patients must understand the potential complications before making a decision.
This article provides a comprehensive look at the risks associated with rhinoplasty, their likelihood, and ways to minimize them.
Common Risks and Complications
Surgical Risks
As with any surgical procedure, rhinoplasty involves inherent risks related to anesthesia and post-operative healing. The likelihood of complications varies depending on individual factors such as health history, surgical technique, and the skill of the surgeon.
Infection is a relatively rare but serious concern, occurring in approximately 1% to 3% of rhinoplasty cases. While antibiotics are typically prescribed to prevent infections, poor post-operative care or exposure to bacteria can still result in complications. If an infection develops, it may lead to prolonged swelling, pain, and in severe cases, abscess formation requiring drainage.
Bleeding, both during and after surgery, is another potential risk. While minor post-surgical bleeding is normal, excessive bleeding can occur in less than 1% of patients. This is more likely in individuals with clotting disorders or those taking blood-thinning medications. Severe bleeding may require additional medical intervention or, in rare cases, a return to the operating room.
Anesthesia reactions, though uncommon, can be serious. General anesthesia is typically safe when administered by a qualified anesthesiologist, but some patients may experience adverse effects such as nausea, dizziness, or, in rare cases, allergic reactions that require emergency medical attention.
Aesthetic Concerns
One of the most significant risks of rhinoplasty is dissatisfaction with the final result. Even when performed by a skilled surgeon, the outcome may not always align with a patient’s expectations. Studies suggest that up to 15% of rhinoplasty patients seek revision surgery to address aesthetic concerns or functional issues.
Asymmetry is a frequent complaint, particularly if post-operative swelling subsides unevenly. In some cases, the nose may appear crooked or unbalanced, which can be difficult to correct without a second procedure. Additionally, overcorrection or undercorrection of nasal features can occur, leading to an unnatural or incomplete result.
Some patients also experience a loss of nasal definition. For example, aggressive cartilage removal can lead to a collapsed nasal bridge or tip, making the nose look pinched. Conversely, insufficient reshaping may not achieve the desired refinement, leaving patients feeling disappointed with their appearance.
Breathing Difficulties
Rhinoplasty is often performed to improve nasal function, but in some cases, the procedure can unintentionally cause or worsen breathing issues. Studies indicate that up to 10% of patients experience nasal obstruction after surgery, which can occur due to excessive scar tissue formation or improper structural changes.
The narrowing of nasal airways is one of the most common causes of post-rhinoplasty breathing problems. This can happen if too much cartilage is removed, weakening nasal support and leading to a collapse of the nasal valve—the narrowest part of the airway. Patients may notice increased difficulty breathing during exercise or while sleeping.
Another potential issue is internal swelling, which can persist for weeks or even months. While temporary swelling is expected, prolonged inflammation may require medical management, including corticosteroids or further surgical intervention.
Scarring and Healing Issues
While closed rhinoplasty (where incisions are made inside the nostrils) leaves no visible scars, open rhinoplasty requires an external incision at the base of the nose. In most cases, this small scar fades over time, but for some patients, it may become raised or discolored. The risk of noticeable scarring is higher in individuals with darker skin tones or those prone to keloid formation.
Healing complications such as delayed wound closure or tissue necrosis are uncommon but can occur, particularly in smokers or those with poor circulation. Smoking constricts blood vessels, reducing oxygen delivery to the surgical site and significantly increasing the risk of complications.
Prolonged swelling and bruising are expected after surgery but typically resolve within a few weeks. However, some patients experience persistent swelling that lasts for several months. This can obscure the final results, making it difficult to assess the true outcome of the procedure until at least a year post-surgery.
Nerve Damage
Temporary numbness around the nose and upper lip is common after rhinoplasty due to nerve disruption during surgery. Most patients regain full sensation within a few weeks to months. However, in rare cases—estimated at less than 5%—nerve damage can be permanent, leading to prolonged numbness or tingling.
Changes in nasal sensation can affect more than just touch; some patients report a diminished sense of smell, particularly if swelling affects the olfactory nerves. While this is usually temporary, lasting only a few weeks, there have been rare reports of long-term olfactory impairment.
Long-Term Risks and Considerations
One of the most overlooked aspects of rhinoplasty is how the nose changes over time. The structure of the nose continues to evolve as scar tissue settles and cartilage adapts. Some patients find that their results shift in unexpected ways years after surgery, necessitating revision procedures.
Revision rhinoplasty carries additional risks, as scar tissue from the initial procedure makes future surgeries more complex. The American Society of Plastic Surgeons estimates that 10% to 20% of rhinoplasty patients eventually undergo a revision, whether for aesthetic refinements or functional corrections.
Beyond physical risks, the psychological impact of rhinoplasty is significant. While many patients feel more confident after surgery, some experience body image dissatisfaction or regret, especially if the outcome differs from their expectations. Individuals with a history of body dysmorphic disorder (BDD) are particularly vulnerable and should carefully consider whether surgery is the right choice.
How to Minimize Risks
While no surgery is risk-free, patients can take several steps to reduce their chances of complications.
Choosing a board-certified plastic surgeon with extensive rhinoplasty experience is the most critical factor in ensuring a successful outcome. Patients should research their surgeon’s credentials, review before-and-after photos, and read testimonials from past patients. A qualified surgeon will also conduct a thorough consultation, discussing the patient’s goals, medical history, and potential risks in detail.
Setting realistic expectations is equally important. No surgery can create “perfection,” and even the best results may have minor imperfections. Patients should have a clear understanding of what is achievable based on their unique facial structure.
Following post-operative care instructions can significantly impact healing and final results. This includes avoiding strenuous activity, keeping the nasal area clean, and attending all follow-up appointments. Patients should also refrain from smoking and limit alcohol consumption, as both can impair the healing process.
Conclusion
Rhinoplasty can be a life-changing procedure, enhancing facial harmony and improving self-confidence. However, it is not without risks. Complications such as infection, breathing difficulties, asymmetry, and the potential need for revision surgery must all be carefully considered before making a decision.
By thoroughly researching the procedure, selecting a skilled surgeon, and maintaining realistic expectations, patients can minimize risks and increase their chances of a satisfying outcome. Those considering rhinoplasty should weigh both the potential benefits and drawbacks to make an informed, confident choice about their surgical journey.
