Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney
Rhinoplasty is one of the most technically demanding operations in plastic surgery. Even with careful planning, meticulous technique, and an experienced surgeon, every patient who has rhinoplasty accepts a degree of surgical risk. The decision to proceed should be made with a clear understanding of those risks rather than from a place of optimism alone. This is the principle behind informed consent and is also what AHPRA requires of every patient considering cosmetic surgery in Australia.
Dr Scott J Turner is a Specialist Plastic Surgeon (FRACS) practising at Bondi Junction and Manly in Sydney. This article walks through the risks and complications of rhinoplasty in detail: the inherent surgical risks that apply to all nasal surgery, the specific aesthetic and functional complications that can develop, the patient factors that change the risk picture, and what is involved in revision rhinoplasty when a previous result needs correction. The intent is to support a balanced, well-informed conversation at consultation rather than to alarm anyone considering the procedure.
Why Risk Discussion Matters
Rhinoplasty changes the structure of a central facial feature. The nose has cosmetic significance and functional roles in breathing, smell, and resonance. The nasal anatomy is small, three-dimensional, and unforgiving. Millimetre-level adjustments produce visible differences in the result, which means small variations in healing also produce visible differences. The skin envelope, the bony framework, the cartilage, and the internal mucosal lining all heal at different rates and behave differently from patient to patient.
This is why even rhinoplasty performed by experienced surgeons has a published revision rate of around 5% to 15% depending on the complexity of the original procedure. Most patients are pleased with the result. A meaningful minority are not. Understanding why before committing to surgery is the most important step a patient can take.
General Surgical Risks
Every surgical procedure carries a baseline set of risks that apply regardless of the operation. For rhinoplasty, these include:
Bleeding
Some minor bleeding from the nostrils is normal in the first few days after rhinoplasty. Significant nosebleeds in the first 72 hours occur in a small percentage of patients and may require additional packing or, rarely, a return to the operating theatre. Patients are instructed to avoid blowing the nose for at least two weeks, sneeze with the mouth open, and avoid medications that thin the blood for two weeks before and after surgery (aspirin, NSAIDs such as ibuprofen, and certain herbal supplements).
Infection
Infection after rhinoplasty is uncommon but possible. Signs include increasing redness, warmth, swelling, pus or unusual discharge, fever, and worsening pain after the first 48 to 72 hours. Prophylactic antibiotics are typically prescribed, and any signs of infection should prompt immediate contact with the surgical team. In rare cases, infection may require surgical drainage and longer antibiotic courses.
Anaesthesia
Rhinoplasty is generally performed under general anaesthesia. Modern anaesthesia is very safe but carries a small risk of complications including allergic reactions, breathing difficulties, blood pressure changes, and rarely more serious cardiac or respiratory events. Temporary cognitive effects such as forgetfulness, slower reaction times, and impaired judgement can occur for a few days after general anaesthesia and are part of the reason patients are advised not to drive or make significant decisions immediately afterwards.
Scarring
In closed rhinoplasty, all incisions are made inside the nostrils with no visible external scars. Open rhinoplasty involves a small incision across the columella (the strip of skin between the nostrils), which typically heals as a fine line that becomes barely noticeable over six to twelve months. Some individuals are prone to keloid (raised, thick) or hypertrophic (raised, red, thickened) scars. Patients with darker skin tones, a personal or family history of keloid scarring, or those who have had problematic scarring elsewhere should discuss this risk specifically at consultation.
Blood Clots
Deep vein thrombosis and pulmonary embolism are uncommon after rhinoplasty because the operation is relatively short and patients mobilise early. Risk is higher in patients with prior history of clotting disorders, certain medications including the contraceptive pill, smoking, and obesity. Mechanical compression devices and early mobilisation are used to reduce risk.
Pain and Discomfort
Most patients describe rhinoplasty pain as moderate and manageable with prescribed analgesia for the first few days. Persistent or worsening pain after the first week should be reported, as it may indicate infection, haematoma, or other complications.
Common Side Effects During Recovery
Side effects are different from complications. The following are part of the normal healing process and are expected:
Swelling and bruising. Swelling around the nose and eyes peaks in the first 72 hours. Bruising typically begins to fade after the third day and resolves over two to three weeks. Most visible swelling settles by six to eight weeks, with residual swelling, particularly at the tip, taking up to twelve months or longer to resolve fully. Patients with thicker skin experience a longer swelling timeline. For more detail, see thick skin in rhinoplasty.
Nasal congestion. Internal swelling, packing (where used), and dried blood inside the nose make breathing through the nose difficult for the first one to two weeks. Saline sprays and gentle saline irrigation help. Mouth breathing during sleep is common in this period.
Numbness. Reduced sensation in the tip of the nose and the upper lip area is common after rhinoplasty and gradually resolves over six to twelve months. Permanent partial numbness occurs in a minority of patients.
Altered smell and taste. A temporary reduction in smell is common in the first few weeks. Permanent change to smell is uncommon, occurring in a small percentage of patients.
Emotional response. Many patients experience a low mood or temporary regret in the first one to two weeks after rhinoplasty when the face is bruised and swollen and the result is not visible. This is a recognised pattern and usually resolves as healing progresses. It is one of the reasons psychological readiness is assessed before surgery.
For a week-by-week guide to recovery, see the week-by-week rhinoplasty recovery timeline.
Aesthetic Complications
Even with technically good surgery, the final aesthetic result depends partly on how the patient heals. For patients concerned about their result during the settling phase, see what if I don’t like my rhinoplasty result. Specific aesthetic complications that can develop include:
Pollybeak Deformity
Fullness in the supratip region (the area just above the nasal tip) that gives the side profile a parrot-beak appearance. Studies suggest pollybeak deformity is one of the more common reasons for revision rhinoplasty. It can be cartilaginous (residual cartilage at the supratip) or soft tissue (scar tissue accumulation). For a detailed explanation, see pollybeak deformity and revision rhinoplasty.
Inverted-V Deformity
Collapse of the middle nasal vault creating a visible inverted V shape when viewed from the front. Caused by inadequate support of the upper lateral cartilages after dorsal hump reduction. Spreader grafts are typically used at primary surgery to prevent this.
Saddle Nose
The nasal bridge appears too low or scooped, creating a concave profile. Causes include over-resection of bone or cartilage, septal collapse, or loss of support after trauma. Correction generally requires structural cartilage grafting, often using rib cartilage. For more details, see what saddle nose deformity is.
Pinched Tip or Nostrils
The nasal tip or nostrils appear unnaturally narrow, sometimes with nostrils taking on a slit-like appearance. Caused by over-resection of the lower lateral cartilages or excessive narrowing during tip surgery. Correction typically requires structural grafting to restore tip support. Tip-specific complications and their surgical correction are covered in detail at tip revision rhinoplasty.
Over-rotated Tip
The tip is angled upward more than intended, sometimes producing a piggy-nose appearance. Difficult to correct because it generally requires lengthening the nose with structural grafts.
Asymmetry
Some degree of asymmetry is common in the early healing phase. Persistent asymmetry of the bony pyramid, the dorsum, or the tip after twelve months may need correction. The face itself is rarely perfectly symmetric, so a degree of imperfection is unavoidable and should be discussed openly at consultation.
Persistent Skin Discolouration
Redness or persistent discolouration on or around the nose can occur, particularly in patients with thinner or fairer skin. Most cases settle over six to twelve months. Sun protection during healing is important.
Visible or Palpable Irregularities
Small contour irregularities of the bone or cartilage may become visible or palpable through the skin as swelling resolves. More common in patients with thinner skin and those who have had revision surgery.
Functional Complications
Rhinoplasty changes the internal architecture of the nose as well as the external shape. For functional complications affecting breathing, see breathing problems after rhinoplasty for the cause-specific surgical options. Functional complications include:
Nasal Valve Collapse
The internal nasal valve is the narrowest part of the airway. If it is weakened during rhinoplasty, particularly through over-resection of the upper lateral cartilages or removal of too much septal support, the airway can collapse during inspiration. Patients describe difficulty breathing through one or both sides, particularly during exercise. For more detail, see understanding nasal valve collapse.
Persistent Septal Deviation
A pre-existing deviated septum that is not adequately corrected at primary surgery, or one that develops or worsens after surgery, can cause persistent breathing obstruction.
Septal Perforation
A hole through the nasal septum is an uncommon but recognised complication. Causes include intra-operative injury, post-operative infection, haematoma, or aggressive septoplasty. Symptoms include whistling on breathing, crusting, recurrent nosebleeds, and altered nasal airflow. Surgical repair is technically difficult and not always successful.
Loss of Sense of Smell
Reduced or absent smell after rhinoplasty is uncommon but can occur, particularly where the procedure involves significant work in the upper nasal vault. Most cases resolve within twelve months.
Patient Factors That Affect Risk
Surgical technique is one part of the risk picture. Patient factors are the other.
Smoking and Nicotine
Nicotine is a vasoconstrictor that significantly reduces blood flow to healing tissue. Smokers have higher rates of wound healing problems, skin necrosis, and overall complications. All forms of nicotine, including patches, gum, vaping, and nicotine pouches, carry the same risk. Cessation for at least four weeks before surgery and four weeks after is recommended, with longer cessation preferable.
Skin Type and Thickness
Thicker, more sebaceous skin is less likely to redrape closely over a newly shaped nasal framework, prolonging swelling and potentially obscuring tip definition. Very thin skin shows underlying bone and cartilage irregularities more readily. Both ends of the spectrum require modified surgical planning.
Previous Nasal Surgery or Trauma
Scar tissue from previous surgery or trauma alters tissue planes and makes dissection more difficult. Cartilage may have been removed or weakened. Revision rhinoplasty, in particular, is technically more demanding and carries a higher risk of needing further correction. See the section on revision risk below.
Age
Rhinoplasty is generally not performed before facial growth is complete (around 15 to 16 in females and 17 in males). At the other end of the spectrum, patients aged 40 and over have been identified in some studies as having a higher rate of complications, though this is not a contraindication. For teenagers, see the teen rhinoplasty page.
Body Dysmorphic Disorder
A small but important subset of patients seeking rhinoplasty have body dysmorphic disorder, a psychiatric condition where preoccupation with a perceived flaw causes significant distress and dysfunction. Surgery does not typically resolve BDD and can worsen distress. Psychological screening at consultation is important for this reason.
Medications and Supplements
Aspirin, NSAIDs, anticoagulants, and certain herbal supplements (fish oil, vitamin E, ginkgo, garlic, ginseng, St John’s Wort) can increase bleeding risk and should generally be stopped two weeks before surgery in consultation with the prescribing doctor.
Cocaine Use
Recreational cocaine use causes severe damage to the nasal lining and septum, impairs healing, and dramatically increases the risk of complications. It is generally considered a contraindication to elective rhinoplasty.
Underlying Medical Conditions
Diabetes, autoimmune conditions, and certain cardiovascular conditions can increase surgical risk. Pre-operative assessment includes a full medical history and any necessary specialist clearance.
Revision Rhinoplasty Risk
Revision rhinoplasty is generally more complex and carries a higher risk than primary rhinoplasty. When complications result in a need for further surgery, the framework for revision rhinoplasty Sydney covers what to look for in a specialist. Reasons include:
- Scar tissue from previous surgery alters tissue planes and makes dissection more difficult
- Native cartilage may have been removed, damaged, or depleted at the primary operation
- Soft tissue envelope behaves less predictably than in a never-operated nose
- Cartilage graft from a second site (ear or rib) may be required, carrying additional donor-site risk
- Published revision rates after revision rhinoplasty (sometimes called secondary revision) are higher than after primary surgery
Patients considering revision should be counselled specifically about these elevated risks. For a fuller discussion, see the revision rhinoplasty page.
How Risk Is Reduced
Risk in rhinoplasty cannot be eliminated. It can be reduced through several measures.
Surgeon selection. A Specialist Plastic Surgeon (FRACS), with specific rhinoplasty experience and a regular volume of cases, is positioned to identify risk factors, plan around them, and manage complications when they occur. Qualifications can be checked on the AHPRA register.
Comprehensive consultation. A thorough consultation includes assessment of the external nasal anatomy, internal examination, photography, discussion of medical history and medications, identification of risk factors, and explicit discussion of realistic outcomes and the specific risks that apply to your case.
Accredited hospital facility. Surgery performed in an accredited hospital with qualified anaesthetists provides a safer environment than office-based or non-accredited facilities. Dr Turner performs surgery in Sydney at Bondi Junction Private Hospital, Delmar Private Hospital in Dee Why, and East Sydney Private Hospital.
Realistic expectations. Patients with realistic expectations about what surgery can and cannot achieve report higher satisfaction. Computer simulation and detailed pre-operative discussion help align expectations with what is achievable for the specific anatomy.
Adherence to pre- and post-operative instructions. Following instructions about medication cessation, smoking cessation, activity restrictions, sleep position, and follow-up appointments significantly reduces complication rates.
AHPRA Cosmetic Surgery Requirements
Cosmetic rhinoplasty is a cosmetic surgical procedure under AHPRA’s regulatory framework. The following requirements apply (effective 1 July 2023):
- GP referral required before the first consultation
- Minimum of two consultations with the operating surgeon before any surgical decision
- Psychological evaluation where indicated
- Cooling-off period between consent and surgery
- All marketing and consultation processes must comply with AHPRA cosmetic advertising rules
These requirements exist specifically to support informed consent and reduce the risk of patients proceeding with surgery they later regret. Where rhinoplasty is performed primarily for functional reasons (correcting a deviated septum, addressing nasal valve collapse, repairing trauma), a different regulatory pathway may apply and Medicare rebates may be relevant. See will Medicare cover my rhinoplasty for more detail.
Consult with Dr Scott J Turner
Dr Scott J Turner is a Specialist Plastic Surgeon (FRACS) with extensive experience in primary and revision rhinoplasty. He consults at Bondi Junction and Manly in Sydney, and at clinics in Brisbane (Spring Hill, Herstellen Clinic) and Canberra (Campbell ACT, Friday consultations).
The consultation discussion includes the realistic outcomes for your specific anatomy, the risks that apply to your case, the alternatives where they exist, and what to expect during recovery. Time is built in to ask questions, take the information away, and decide without pressure.
Contact the practice to arrange a consultation, or read more about Dr Turner’s background and training.
Frequently Asked Questions
What are the most common risks of rhinoplasty?
The most common general surgical risks are bleeding, infection, anaesthetic complications, and visible scarring. Specific to rhinoplasty, the most common aesthetic complications include pollybeak deformity, asymmetry, and irregularities visible or palpable through the skin. Functional complications include nasal valve collapse, septal perforation, and breathing obstruction. The published revision rate for rhinoplasty is approximately 5% to 15% depending on the complexity of the original procedure.
How long does it take to know if my rhinoplasty result is final?
Most visible swelling settles by six to eight weeks, but full settling of the nose, particularly the tip, takes twelve months or longer. Patients with thicker skin often need eighteen months for the result to fully mature. Revision surgery is generally not considered until at least twelve months have passed, often eighteen months in thick-skinned patients, to allow tissues to heal and stabilise.
Is revision rhinoplasty riskier than primary rhinoplasty?
Yes. Revision rhinoplasty is technically more demanding than primary surgery because the anatomy has been altered, scar tissue is present, native cartilage may be depleted, and the soft tissue envelope behaves less predictably. The need for autologous cartilage graft from a second site, the ear or rib, is more common in revision cases. Published revision rates after revision rhinoplasty are higher than after primary surgery.
Can rhinoplasty cause permanent breathing problems?
In a small percentage of cases, rhinoplasty can result in worsened breathing due to nasal valve collapse, septal perforation, internal scarring, or inadequate correction of pre-existing structural problems. Most breathing complications can be addressed with revision surgery, but not all cases are fully reversible. Discussing functional concerns alongside aesthetic goals at primary consultation is important.
What can I do to reduce my own risk before surgery?
Stop all forms of nicotine for at least four weeks before and after surgery. Stop aspirin, NSAIDs, and bleeding-risk supplements two weeks before surgery in consultation with your prescribing doctor. Maintain a stable weight. Manage any underlying medical conditions. Be honest with your surgeon about your medical history, medications, and substance use. Follow all pre- and post-operative instructions carefully and attend all follow-up appointments.
