Serious complications from rhinoplasty surgery are extremely rare. Facial plastic surgery complications with significant impact on a patient’s health are usually anesthesia-related. Therefore, it is important to consider anesthesia choices when undergoing a rhinoplasty procedure. As with any surgical procedure, complication risks can often be minimized if the operation is performed by an experienced physician; for a rhinoplasty this would be a skilled facial cosmetic surgeon with experience in nasal surgery. Although there are many rare theoretical problems that could result from nasal reshaping surgery, below is a list of complications you may want to know about before you make your final decision.
Bleeding is probably one of the more common situations that can arise from a rhinoplasty. There are two kinds of bleeding concerns surrounding nasal surgery: bleeding during rhinoplasty and bleeding during the recovery. Most of us had a nose bleed before or at least have seen somebody with spontaneous nasal oozing or hemorrhage as a result from nasal trauma. This gives one an idea about the rich vascular supply of the nose and indicates that surgery may lead to nasal bleeding (also called epistaxis). Normal bleeding during the surgery is minimal with blood loss often less than 50cc. In extremely rare situations, bleeding may be significant enough that an alternate treatment plan needs to be employed by the nasal surgeon. All experienced rhinoplasty surgeons are knowledgeable in treating nasal bleeding. If excessive bleeding happens during surgery, cauterization of the blood vessel or packing of the nose to apply prolonged pressure to the area of oozing is often employed. Bleeding after rhinoplasty may happen from just a few minutes after surgery up to two weeks. Delayed bleeding is usually a result of a vessel being exposed during the healing process. This may be more likely with elevated blood pressure or if one blows the nose. If this happens, the patient should contact his or her surgeon right away. Although exceedingly rare, any severe nose bleed may continue to the point when blood transfusion becomes necessary. Ask your rhinoplasty surgeon about his experience with nose bleeds after or during rhinoplasty.
Infections after rhinoplasty surgery are rare. Sterile surgical technique, the use of prophylactic antibiotics and the rich blood supply of the nose make infections after rhinoplasty rather unlikely. An infection of the nose may present with increased redness, swelling and pain. If implants were used in the nose (i.e., silicone implants, Goretex or other materials) these materials usually have to be removed in order to successfully and safely treat the infection. Your plastic surgeon likely will treat you with antibiotics; sometimes infectious fluid will need to be drained.
There will be scars where the rhinoplasty incisions are placed. Usually these incision are within the nose and therefore not noticeable (endonasal rhinoplasty). Sometimes, a small scar is at the outside of the nose (open rhinoplasty technique) which rarely causes cosmetic concerning marks. Although good wound healing after this procedure is expected, abnormal scars may occur. Inside scars may lead to narrowing of the airway and even nasal obstruction. Sometimes, the nasal surgeon may discuss with the patient the possibility to narrow the nostrils. This is often done through incisions at the outside and may lead to scars that could be bothersome to the patient. Aside from these rare scars from surgical incisions, “scarring” as a concern in rhinoplasty is more pertinent in scarring underneath the skin because it has direct influence on the final cosmetic result. Such scarring may lead to poor tip definition, deviation of the nose to one side (crooked nose) and other imperfections. Some surgeons feel that they can guide the scarring during follow up visit after rhinoplasty by use of steroid injections into the nose.
Damage to Surrounding Structures
Any structure that is close to the operated nose is potentially at risk. This includes the tear duct which drains tears from the inside of the eyes into the nose. Injury of this duct may lead to tearing of the eyes. The nasal septum attaches to the skull base. There are reports of skull injury and drainage of brain fluid (cerebrospinal fluid = CSF) may develop. If deeper blood vessels are injured severe nasal bleeding may develop.
Local, sedative and general anesthesia involve risks. Discuss the anesthesia related risks with your doctor before your rhinoplasty surgery.
Any change to the outside of the nose will invariably alter the nasal air flow. Therefore, the experience rhinoplasty surgeon will maximize breathing if he feels that normal breathing could be jeopardized. Techniques include straightening a deviated nasal septum (i.e., septoplasty), minimizing the prominence of nasal turbinates (i.e., turbinoplasty) and placement of cartilage grafts to increase the resilience of the nasal side walls. Despite the surgeon’s best efforts, obstructed nasal breathing may not improve or even get worse after rhinoplasty surgery. Paradoxically, too much room inside the nose may lead to the sensation of obstructed nasal breathing and continued crusting after nasal surgery – a condition quite difficult to treat. Your surgeon’s thorough understanding of the nasal anatomy will ensure that risks to nasal airway obstruction after rhinoplasty are kept at a bare minimum.
Nasal Septum Perforation
Because of the impact on nasal breathing and the difficulty to repair perforations of the nasal septum, this is a feared problem after rhinoplasty. The consequences of a septal hole are directly related to the size of the perforation: small perforation may create a whistling sound and may be the source for intermittent oozing. If the septal perforation is large, crusting can develop and constant difficulties breathing through the nose.
Although not a complication in a true medical sense, the overall cosmetic outcome is probably the most common reason for an unhappy patient after rhinoplasty. The consultation with your nasal surgeon should be the time to discuss thoroughly expectation and limitations of rhinoplasty for you. An experienced cosmetic nose surgeon will know within certain limits what he is able to achieve for you dependent on your particular nasal anatomy. In addition, your rhinoplasty surgeon will also point out what may not be realistic to hope for. Have an honest discussion with your facial plastic surgeon and mention all areas of concern. Then ask him to show you on your nose what he thinks the final result might be. For profile analysis, computer imaging systems are a helpful communication tool but have their limitations because it is only virtual reality.
Revision rhinoplasty is a relatively common procedure. Reports indicate that between 10 to 20% (one in 5) of rhinoplasty patients may seek secondary surgery. One has to distinguish between major and minor revisions. Minor revisions represent small touch-up procedures. Often, a little bone edge is smoothened or a millimeter more nasal hump shaved. Although it may represent an inconvenience to the patient, these minor nasal procedures are much easier than for instance having to put more cartilage back in. If this is the case, one looks at a major revisions rhinoplasty.
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