Risks and Considerations

Rhinoplasty – Risks and Considerations

Rhinoplasty is a surgical procedure involving the nose. It may be considered for functional reasons (such as breathing difficulties) or to address structural or aesthetic concerns. Like all surgical procedures, rhinoplasty carries potential risks and limitations. Understanding these risks and setting realistic expectations is essential before deciding to proceed.

General Surgical Risks

These risks may apply to most surgical procedures, including rhinoplasty:
• Bleeding (Epistaxis): Minor bleeding is common. In rare cases, significant bleeding may require medical intervention.
• Infection: Although uncommon, infections can occur and are typically managed with antibiotics.
• Adverse reaction to anaesthesia: Reactions to anaesthesia may include nausea, allergic response, or in rare cases, more serious complications.
• Delayed wound healing: Scarring may become raised or uneven. This is more likely in smokers or patients with certain medical conditions.
• Hematoma: Accumulation of blood under the skin may occur and occasionally requires drainage.
• Postoperative discomfort: Pain or pressure is usually mild to moderate and can be managed with appropriate medications.

Procedure-Specific Risks

Functional Risks
• Breathing difficulties: Changes in nasal anatomy or post-operative swelling can impact airflow.
• Temporary numbness: Sensation loss around the nasal tip, upper lip or teeth is common and usually resolves over time.
• Reduced sense of smell: Swelling in the nasal passages may temporarily affect the sense of smell.
• Septal perforation: A hole in the septum may occur. It may lead to symptoms such as whistling, crusting, or bleeding.
• Voice changes: Very rare. Subtle vocal changes may be noticed, particularly by professional voice users.

Aesthetic and Structural Considerations

• Differences from expected appearance: Final results may differ from pre-surgical expectations due to anatomical and healing variables.
• Visible scarring: More likely with open rhinoplasty. Most scars fade over time, but individual results vary.
• Persistent swelling and bruising: Facial swelling typically resolves within a few weeks. Nasal swelling may continue for 12 to 18 months.
• Irregular contour: Unevenness or bumps may occur and can be more apparent in individuals with thinner skin.
• Skin changes: Temporary changes such as redness, irritation, or pigmentation differences may occur. These usually resolve with healing but may persist in some cases.
• Numbness of the nose or upper teeth, generally temporary.

Structural Complications

• Pollybeak deformity: A bulging appearance above the nasal tip due to scar tissue or incomplete reduction of tissue.
• Saddle nose deformity: Collapse of the nasal bridge, often due to excessive removal of cartilage or tissue.
• Inverted-V deformity: Collapse or narrowing of the upper lateral cartilages, typically after dorsal hump removal.
• Nasal valve collapse: Weakening of the nasal sidewalls may obstruct breathing.
• Tip asymmetry: Slight differences in nasal tip shape can occur due to healing, anatomical factors, or surgical limitations.

Revision Surgery

In some cases, individuals may consider additional (revision) surgery following initial rhinoplasty. This may be for functional concerns (such as nasal obstruction) or structural issues (such as asymmetry or irregularities). Revision rhinoplasty is typically more complex due to scar tissue, changes in nasal anatomy, and reduced tissue availability. For this reason, it is generally recommended to wait at least 12 to 18 months after the original procedure before considering revision surgery.

Psychological Considerations

• Emotional adjustment: Swelling and bruising can significantly alter appearance in the early healing phase. This may lead to temporary concern or anxiety as the final result evolves.
• Body image: Rhinoplasty may not lead to increased self-esteem, particularly in individuals with underlying psychological conditions such as body dysmorphic disorder (BDD).
• Satisfaction depends on preparation: Patients who are well-informed and have realistic expectations are more likely to be satisfied with their outcomes.

Setting Realistic Expectations

• Improvement, not perfection: The goal of rhinoplasty is to improve nasal form or function. Minor imperfections or asymmetries are common.
• Healing is gradual: Nasal tissues take time to settle. Final results are typically evident between 12 and 18 months post-surgery.
• Anatomical limitations exist: Factors such as skin thickness, cartilage strength, and facial proportions influence what is surgically possible.
• Imaging tools are only estimates: Computer simulations are planning tools and do not guarantee actual results.
• Clear communication is key: Discussing goals, risks, and limitations with your surgeon is essential in making an informed decision.

Recovery Overview

• Initial recovery (2–4 weeks): Swelling, bruising, and nasal congestion are expected during this period.
• Return to work: Most individuals return to work or study within 2–4 weeks, depending on their healing and comfort.
• Exercise restrictions: Strenuous activity (e.g. heavy lifting, running) should be avoided for 4–6 weeks.
• Final results: The nose continues to refine over time, with tip swelling resolving more slowly in patients with thicker skin.

How to Minimise Risk

• See a registered specialist: Your surgeon should hold specialist registration with the Medical Board of Australia.
• Stop smoking: Smoking impairs wound healing and increases the likelihood of complications.
• Follow aftercare instructions: Adhering to post-operative care supports safer recovery and better outcomes.
• Attend follow-up appointments: Continued assessment allows for early detection and management of any concerns.

Important Disclaimer

This information is general in nature and intended for individuals aged 18 years and over. It is not a substitute for medical advice. Rhinoplasty should only be considered after consultation with a registered medical practitioner who can assess your individual suitability, discuss risks, and provide written information to support informed consent.