Rhinoplasty Risks and Complications

Anyone considering surgery should approach the decision with a healthy amount of respect and caution especially when the surgery is elective (or planned) and is non essential surgery (as aesthetic or cosmetic surgery generally is). All surgical procedures have limitations in terms of achievable outcomes and it is important that your expectations match what is possible through surgery. The choice to go ahead with surgery should always be taken after due consideration of the risk benefit balance for the procedure. Although the majority of patients do not experience problems it is important that you fully understand all the potential risks and complications of Rhinoplasty surgery. It is important that you take the time to read over them again prior to your next consultation.

Asymmetry

A symmetrical facial appearance may not result from Rhinoplasty. Factors such as skin thickness, inherited features, skeletal prominence, and previous surgery or injury may contribute to asymmetry in nasal features. Most patients have differences between the right and left side of their face before any surgery is performed. Every effort will be made to achieve good symmetry after your surgery. However there will inevitably be subtle differences to each side of the nose and the potential for these differences must be accepted by you if you are undergoing Rhinoplasty surgery. However, occasionally there are significant asymmetries and irregularities that need addressing with further surgery (a revision operation). Revision rates for Rhinoplasty surgery are around 10%. Additional surgery may be necessary to revise asymmetry after Rhinoplasty.

Bleeding and Bruising

All patients get bruising of their nose and face after Rhinoplasty. This diminishes over time but in some patients this can last for many months. Rarely there are permanent pigmentation changes around the eyes following Rhinoplasty. It is possible, though unusual, to experience a bleeding episode during or after surgery. Most of the time this bleeding stops by lying down, sitting up and applying gentle pressure on the nose. Rarely, should post-operative bleeding occur that does not stop, it may require emergency treatment. Do not take any aspirin or anti-inflammatory medications for ten days before surgery, as this may increase the risk of bleeding. Non-prescription “herbs” and dietary supplements can increase the risk of surgical bleeding. Haematoma can occur at any time following injury to the nose. If blood transfusions are needed to treat blood loss, there is a risk of blood-related infections such as hepatitis and the Human Immunodeficiency Virus (the virus that causes AIDS).

CSF Rhinorrhoea

Very rarely, damage to the thin plate of bone separating the nose from the nerves that detect smell (which lie under the front of the brain) can be damaged. This is an extremely unusual but important risk. The fluid that may leak out is clear and is called CSF (cerebrospinal fluid). Most leaks heal spontaneously, but occasionally further surgery is required.

Infection

Rates of severe infection in Rhinoplasty are low (despite the surgery being in the nose) – quoted at around 2%. However, minor wound infections or inflammation may occur – if it does happen, an infection will be treated with antibiotics. Rarely, a return to the operating theatre to wash out the nose might be required.

Skin necrosis

Despite the skin being lifted off the underlying nose, the blood supply is usually good, and the skin heals well. Rarely, the blood supply to the skin of the nose is damaged during surgery, and areas of skin death can occur. If so, these are most likely to be at the nasal tip. Dressings may be required to speed up healing, and further surgery in the future may be needed should this happen.

Change in sense of smell

A small proportion of people may experience a reduction in their sense of smell after Rhinoplasty surgery. Whilst in some cases this will be due to prolonged internal swelling (which will then resolve and the sense of smell will return), in others, it is due to the nerves that detect smells being affected by the surgery. In these instances, which are fortunately rare, the change or reduction in the sense of smell may be permanent.

Change in Skin Sensation

You may experience a diminished (or loss) of sensitivity of the nose and the skin which usually improves over time. Permanent loss of sensation can occur after Rhinoplasty but is rare.

Damage to Deeper Structures

There is the potential for injury to deeper structures including, nerves, blood vessels, muscles, and cartilage during any surgical procedure. The potential for this to occur varies according to the type of procedure being performed. Injury to deeper structures may be temporary or permanent.

Delayed Healing

If an incision is made on the nose the wounds usually heals well. Rarely wound disruption, scar asymmetry or delayed wound healing can occur.

Scarring

All surgery leaves scars, some more visible than others. Although good wound healing after a surgical procedure is expected, abnormal scars may occur within the skin and deeper tissues. Scars may be unattractive and of a different colour to the surrounding skin tone.

Scar appearance may also vary within the same scar. Scars may be asymmetrical (appear different on the right and left side of the body. There is the possibility of visible marks in the skin from sutures. In some cases, scars may require surgical revision or treatment. Scars change with time and can get thicker.This can occur to scars inside the nose also.

Swelling and Seroma

All patients will experience swelling after Rhinoplasty. This improves with time but in some patients this can take many months. Fluid accumulations infrequently occur in between the skin and the underlying tissues. Should this problem occur, it may require massage or steroid injections. Rarely there is permanent swelling of the nose leading to asymmetry.

Excessive Callus Formation

When the nasal bones are broken so they can be realigned, they take several weeks to heal. The healing process involves the body laying down a substance known as callus, which is new bone scar tissue. In some people, excessive amounts of callus can be produced, leaving hard lumps palpable (or occasionally visible) under the skin on either side of the nose. If this occurs and does not settle down over time, surgery might be required to remove them. However, further surgery, in turn carries the risk that more callus may occur to heal the new wound. An assessment of your individual situation will need to be done in order to plan the best course of action.

Nasal Obstruction

Long-term swelling of the internal tissues, or thickening of the tissues on the inside of the nose may rarely result in reduced air flow in the nostrils. This can leave you feeling as though you have a permanently blocked nose. Further procedures may be needed should this occur. The procedures required are usually performed by an ENT surgeon.

Skin Contour Irregularities

Contour and shape irregularities may occur after Rhinoplasty. Visible and palpable wrinkling may occur.

Skin Sensitivity

Itching, tenderness, or exaggerated responses to hot or cold temperatures may occur after surgery. Usually this resolves during healing, but in rare situations it may be chronic.

Surface changes

Contour irregularities in the skin may result after Rhinoplasty and can be felt when the nose is touched. This may improve with time but some irregularities are permanent due to the nature of how nasal bones and cartilage heal. There is also scarring in the area, as with all forms of surgery, which is a normal response by the body to injury.

Surgical Anaesthesia

Both local and general anaesthesia involves risk. There is the possibility of complications, injury, and even death from all forms of surgical anaesthesia or sedation.

Sutures

Most surgical techniques use deep sutures. You may notice these sutures after your surgery. Sutures may spontaneously poke through the skin, become visible or produce irritation that requires removal.

Long-term Results

Subsequent alterations in the nose shape may occur as the result of ageing, sun exposure or other circumstances not related to your surgery.

Pain

You will experience pain after your surgery. We will try and minimise this with anaesthetic and pain medication.

Allergic Reactions

In rare cases, local allergies to tape, suture material, glues, blood products, topical preparations or injected agents have been reported. Serious systemic reactions including shock (anaphylaxis) may occur to drugs used during surgery and prescription medications. Allergic reactions may require additional treatment.

Deep Venous Thrombosis, Cardiac and Pulmonary Complications

Surgery, especially longer procedures, may be associated with the formation of, or increase in, blood clots in the venous system. Pulmonary complications may occur secondarily to both blood clots (pulmonary emboli), fat deposits (fat emboli) or partial collapse of the lungs after general anaesthesia. Pulmonary and fat emboli can be life-threatening or fatal in some circumstances. Inactivity and other conditions may increase the incidence of blood clots travelling to the lungs causing a major blood clot that may result in death.

It is important to discuss with your doctor any past history of blood clots or swollen legs that may contribute to this condition. Cardiac complications are a risk with any surgery and anaesthesia, even in patients without symptoms. If you experience shortness of breath, chest pains, or unusual heartbeats, seek medical attention immediately. Should any of these complications occur, you may require hospitalisation and additional treatment.

Unsatisfactory Result

Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained. You may be disappointed with the results of Rhinoplasty surgery. Asymmetry in the nose or unanticipated changes of shape and size may occur after surgery. As well as unsatisfactory surgical scar location, visible deformities, loss of function, wound disruption, poor healing, loss of sensation and failure to achieve the aims may occur. It may be necessary to perform additional surgery to improve your results which is chargeable.

Complications associated with rib cartilage harvest

Adverse scarring: as described above.

Infection: As described above. Additionally, if the chest cavity were to become infected further treatment including intravenous antibiotics or surgery may be required.

Pneumothorax This is the presence of air within the chest cavity that results from a tear in the lining of the chest (the pleural membrane). This may require the insertion of a tube into the chest for a few days in order to re-inflate the lung.

Contour defect of the chest wall: After the removal of cartilage from the rib, it is possible for there to be a visible dip in the chest wall.

Bleeding: as described above.

Seroma formation: as described above.

Pain: As described above. Additionally, it is possible for nerves to become trapped in scar tissue which can lead to numbness, alterations in sensation to the chest wall, discomfort or even pain. This could be temporary or permanent.

Complications associated with ear cartilage harvest (conchal bowl):

Bleeding: As described above.

Infection: As described above. Additionally, if the ear cartilage were to become infected this could result in loss of the cartilage and loss of ear shape.

Seroma formation: As described above.

Change in ear prominence: Harvesting the conchal bowl (the inner portion or the bowl of the ear) may affect the prominence or degree to which the ear(s) stick out from the side of the head. The change can result in asymmetry of ear appearance.

Adverse scarring: As described above.

Complications associated with temporalis fascia harvest:

Bleeding: As described above.

Infection: As described above.