Last Updated May 2025

Rhinoplasty (nose surgery) offers both cosmetic and functional benefits, but like any surgery, it comes with potential risks. At Dr Scott J Turner’s specialist plastic surgery clinics in Manly and Double Bay, we believe informed patients make better decisions.

This guide explains what you should know about rhinoplasty complications to help you decide if this procedure is right for you. Whether you’re considering cosmetic rhinoplasty, functional rhinoplasty to improve breathing, or revision rhinoplasty to address previous surgical issues, understanding the risks is essential. Remember that full results take time – your final nose shape may not be apparent until swelling completely resolves, which can take up to a year.

Table of Contents

Universal Surgical Risks

Like all surgical procedures, rhinoplasty carries certain inherent risks that apply to both cosmetic and functional interventions:

Bleeding

Some minor bleeding in the first few days is normal
About 3% of patients have nosebleeds in the first 72 hours
Most bleeding stops within a week
Severe bleeding needing treatment occurs in about 1-2% of cases

Infection

About 3% of patients may experience infection
Signs include unusual dryness, discharge, congestion, or crusting that lasts more than a week
Most infections can be treated with antibiotics
Recovery time depends on your specific surgery
Serious infections are rare

Anaesthesia Risks

General anaesthesia is typically used for rhinoplasty and carries its own set of risks:

Reactions can range from mild (nausea, skin rash) to severe (anaphylaxis, pneumonia, blood clots)
Patients who smoke have an increased risk of anaesthesia-related complications
Temporary cognitive effects like forgetfulness, slower reaction times, and impaired judgment can occur for a few days after anaesthesia

Scarring

All surgical procedures result in scars, though their visibility varies:

In closed rhinoplasty, all incisions are made inside the nostrils with no visible external scars
Open rhinoplasty involves a small incision across the columella (strip between nostrils), which typically heals as a barely noticeable line
Some individuals may develop keloid (raised, thick scars) or hypertrophic (raised, red, thickened) scars

Immediate Post-Operative Experiences

Following rhinoplasty, certain experiences are very common and generally part of the normal healing process:

Swelling and Bruising

Swelling will be noticeable around the nose and eyes, often peaking within the first few days
Bruising typically begins to improve after the third day but can persist for two to three weeks
While prominent swelling subsides relatively quickly, residual swelling, particularly at the nasal tip, can take up to a year or longer to fully resolve
Management strategies include keeping the head elevated, applying cold compresses to the cheeks (not directly on the nose), and maintaining a low-sodium diet

Pain and Discomfort

Some degree of pain or discomfort is expected after surgery
This is generally mild to moderate and can be effectively managed with prescribed pain medication
Pain should typically improve within the first week

Nasal Stuffiness and Initial Breathing Difficulty

It is common to feel congested and find it difficult to breathe through the nose immediately after surgery
This is often due to internal swelling, as well as the presence of internal splints or packing, if used
Breathing usually improves as swelling subsides and any packing or splints are removed

Functional Complications

Functional complications can affect nasal breathing and overall quality of life:

Breathing Changes

Breathing difficulties are a common concern after rhinoplasty
About 5-10% of patients may not see breathing improvement after surgery
Risk factors include removing too much tissue or weakened cartilage support
Choosing an experienced surgeon like Dr. Turner reduces these risks
Patients who need revision surgery often report breathing problems

Septal Perforation

A hole in the wall between nasal passages occurs in about 1-2% of patients
Symptoms can include whistling when breathing, crusting, and nosebleeds
This can be difficult to repair
Risk is higher with previous nasal injuries or surgery

Sensory and Neurological Considerations

Rhinoplasty can temporarily or permanently affect sensory functions:

Changes in Smell and Taste

Alterations in smell (hyposmia) reported in approximately 3.1% of patients
Most cases resolve within 2-6 months after surgery
Since smell contributes significantly to taste perception, temporary changes in taste may also occur
Permanent loss of smell is very rare, estimated at less than 0.5% of cases

Numbness and Sensory Changes

Temporary numbness around the nose is common immediately after surgery
Some patients experience temporary numbness of the upper lip or teeth
Most sensory changes resolve gradually over weeks to months
This occurs because small sensory nerves supplying the skin are inevitably cut or disturbed during surgical dissection
In rare cases, some degree of permanent numbness can persist

Aesthetic Complications

For those seeking cosmetic improvements, certain aesthetic complications may occur:

Asymmetry and Irregularities

Some degree of minor asymmetry is not uncommon even with careful planning
Visible or palpable irregularities may develop along the nasal dorsum
Perfect symmetry is rarely achievable as faces are naturally somewhat asymmetric
Skilled surgical technique and proper patient selection help minimise these risks

Specific Deformities

Certain characteristic deformities can develop following rhinoplasty:

“Pollybeak” deformity: Fullness in the supratip area giving a parrot-beak appearance, accounting for approximately 50% of revision rhinoplasty cases
Inverted-V deformity: Collapse of the middle vault creating a visible inverted V shape when viewed from the front
Scooped Bridge/Saddle Nose: The bridge appears too low or “scooped out,” creating a concave profile, often from excessive removal of bone or cartilage
Pinched Tip/Nostrils: The nasal tip or nostrils appear unnaturally narrow or elongated, sometimes with nostrils taking on a slit-like appearance
Overly Rotated/Turned-Up Tip: The nasal tip is angled upwards excessively
These complications often necessitate revision procedures

Skin-Related Issues

Persistent skin discoloration, such as redness on or around the nose, can occur
Darkening of the skin under the eyes is another potential issue that may last for six months or longer
Small blood vessels on the skin’s surface can sometimes burst, leading to tiny red marks
Changes in skin sensation, such as increased sensitivity or altered feeling, are also possible

Severe But Rare Complications

Though extremely uncommon, serious complications can occur:

Cerebrospinal Fluid Leak

Occurs when surgical manipulation inadvertently affects the cribriform plate or skull base
Creates potential communication between the nasal cavity and brain
Requires immediate neurosurgical attention
Extremely rare with proper surgical technique

Ocular Complications

May occur during osteotomies (controlled bone fractures)
Range from minor to severe issues
Proper surgical planning and technique virtually eliminate these risks

Patient-Specific Risk Factors

Several personal factors can significantly influence your individual risk profile:

Smoking and Vaping

Smoking significantly increases risks for complications
Reduces blood flow to healing tissues
Increases risks of infection and poor healing
Must quit at least 6 weeks before surgery and throughout recovery

Medical Conditions

Uncontrolled diabetes: Compromises the body’s ability to heal and fight infection
High blood pressure: Can lead to increased bleeding during and after surgery
Bleeding disorders: May make a patient unsuitable for elective rhinoplasty
Obesity: Associated with higher risk of surgical and anaesthesia complications
Sleep apnea: May be a contraindication for rhinoplasty in some cases

Nasal Anatomy & History

Skin thickness: Thick nasal skin limits refined definition and contributes to prolonged swelling; very thin skin may make cartilage irregularities more visible
Previous nasal trauma or surgery: Significantly increases surgical complexity due to scar tissue and altered anatomy
Deviated septum: If not adequately addressed, can lead to persistent breathing problems
Ethnic background: Variations in skin type, cartilage strength, and bone structure influence surgical techniques and outcomes

Other Important Factors

Age: Surgery typically deferred until facial growth is complete (15-16 for females, 17 for males); age ≥40 identified as an independent risk factor for major complications
Body Dysmorphic Disorder (BDD): May not be good candidates as surgery may not alleviate underlying psychological distress
Cocaine use: Causes significant damage to nasal structure, impairs healing, and dramatically increases risk of complications; strong contraindication for rhinoplasty
Certain medications: Aspirin, NSAIDs (ibuprofen), some herbal supplements can increase bleeding risk

The Possibility of Revision Rhinoplasty

Despite the surgeon’s best efforts and the patient’s diligent adherence to care instructions, there are instances where additional surgery may be necessary:

Published rates for revision rhinoplasty vary, with some sources indicating a range of 5% to 15.5%

Reasons for Revision Surgery

Patients may seek revision rhinoplasty for various reasons:

Aesthetic dissatisfaction: Persistent asymmetry, residual bumps, overcorrected or undercorrected appearance
Functional problems: New or persistent breathing difficulties, nasal valve collapse
Healing complications: Unpredictable healing leading to excessive scar tissue or displacement of cartilage grafts

Increased Complexity of Revision Surgery

Revision rhinoplasty is generally more complex and technically challenging:

Scar tissue alters normal tissue planes, making dissection more difficult
The surgeon works with an already modified and potentially weakened structure
Septal cartilage may have been used, damaged, or depleted during the primary surgery
Nasal tissues can become more fragile with each subsequent surgical intervention

Minimising Your Risks: The Importance of Surgeon Selection

The single most important factor in minimising rhinoplasty complications is selecting a qualified and experienced surgeon:

Dr Scott J Turner is a Specialist Plastic Surgeon with extensive training and experience in rhinoplasty procedures
Comprehensive pre-operative assessment identifies individual risk factors
Fully accredited hospital facilities with qualified anaesthetists ensure optimal safety
Patients in Australia should verify that their surgeon holds appropriate qualifications, such as being a Fellow of the Royal Australasian College of Surgeons (FRACS) with specific training in plastic surgery

Preparing for Surgery: Pre-Operative Care

Thorough preparation in the weeks leading up to surgery can significantly impact safety and recovery:

Lifestyle Adjustments

Quit smoking/vaping at least 6 weeks before surgery and continue abstaining throughout recovery
Avoid medications and supplements that increase bleeding risk for about two weeks before and after surgery
Avoid alcohol for at least five days to a week prior to surgery
Maintain a healthy weight and physical condition

Pre-operative Instructions

Follow all specific guidelines provided by your surgeon
Arrange for transportation to and from the surgical facility
Organize assistance at home during the initial recovery period

Diligent Post-Operative Care

Strict adherence to post-operative instructions is vital for optimal healing and minimizing complications:

Essential Post-Operative Guidelines

Rest with head elevated higher than chest for the first few days
Avoid strenuous physical activities for several weeks (typically 3-6 weeks)
Do not blow your nose for at least 7-14 days
Avoid rubbing or putting pressure on the nose for at least 8 weeks
Follow specific instructions for cleaning and caring for your nose
Take all prescribed medications exactly as directed
Maintain a low-sodium diet to help minimize swelling
Protect your nose from sun exposure with broad-spectrum sunscreen
Do not rest eyeglasses directly on the bridge of the nose for at least four weeks
Attend all scheduled follow-up appointments

Recognizing Warning Signs

Be aware of symptoms that should prompt immediate contact with your surgeon:

Fever (temperature above 38°C/101°F)
Excessive or heavy bleeding that doesn’t stop with gentle pressure
Uncontrolled or worsening pain not relieved by prescribed medication
Signs of infection (increased redness, warmth, swelling, pus, or foul-smelling discharge)
Constant clear, watery nasal discharge from one side (could indicate cerebrospinal fluid leak)
Visual disturbances or any other unusual symptoms

The Emotional Journey

Rhinoplasty is more than just a physical change; it often involves significant emotional aspects:

The extended healing process (up to a year or more) can be challenging
Some patients experience temporary anxiety or doubt during the swelling phase
Having realistic expectations from the start helps manage emotional responses
Open communication with your surgeon throughout the process is essential
For those experiencing significant emotional distress, seeking psychological support can be beneficial

Making an Informed Decision

While complication rates for rhinoplasty are relatively low (approximately 3-5% overall), understanding potential risks allows for informed consent and appropriate expectations:

Weigh potential benefits against possible risks
Consider both functional and aesthetic goals
Understand that the goal is improvement, not perfection
Recognize that final results take time to emerge as swelling subsides
Be aware that revision surgery may be needed in some cases
Follow all pre and post-operative instructions carefully
Attend all scheduled follow-up appointments

Contact Us

If you’re considering rhinoplasty and would like to discuss your specific concerns and goals, we invite you to schedule a consultation with Dr Scott J Turner, Specialist Plastic Surgeon. A thorough consultation is essential for establishing realistic expectations and developing a personalized surgical plan.

Contact our friendly team at our Manly or Double Bay clinics to arrange your appointment.

Disclaimer: This article is intended for general informational purposes only and does not constitute medical advice. Every patient is unique, and individual results may vary. The information provided here is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your surgeon with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen. Dr Scott J Turner is a Specialist Plastic Surgeon (FRACS) performing cosmetic and reconstructive surgery in Sydney, Australia.

Understanding Rhinoplasty Risks and Complications