What are the potential complications of rhinoplasty?

Potential Complications of Rhinoplasty

The major complication rate following rhinoplasty is low at approximately 0.7%, but patients should be informed about both major and minor complications that can occur, including bleeding, infection, breathing difficulties, and aesthetic deformities.

Major Complications

• Hemorrhage/Hematoma (0.2%) - Can range from minor epistaxis to severe bleeding requiring transfusion 1
• Infection (0.2%) - From localized abscesses to rare but serious complications like cavernous sinus thrombosis, meningitis, or toxic shock syndrome (especially with nasal packing) 2, 3
• Orbital/Ocular Injuries - Can include periorbital ecchymosis, orbital hematoma, and in rare cases, blindness from central artery occlusion 2
• Intracranial Complications - Extremely rare but serious complications include cerebrospinal fluid leak, meningitis, and brain damage 4, 2
• Pulmonary Complications (0.1%) - Risk increases significantly when rhinoplasty is combined with other procedures 1

Minor Complications

• Postoperative Edema and Ecchymosis - Common and unavoidable but can be minimized with head elevation and cold packs 3
• Synechiae (Bridging Scar Formation) - Often occurs between middle turbinate and lateral nasal wall or nasal septum 4
• Septal Perforation - Can occur during surgery or in the postoperative period 4
• Nasal Valve Collapse - Results in breathing difficulties due to inadequate structural support 2
• Skin Complications - Include atrophy, fibrosis, numbness, cysts, and subcutaneous granulomas 2

Aesthetic Complications

• Pollybeak Deformity - Supratip fullness, occurs in approximately 50% of revision rhinoplasties 2, 3
• Saddle Nose Deformity - Results from overaggressive hump removal 3
• Persistent Hump - Due to inadequate reduction of bony or cartilaginous hump 3
• Tip Deformities - Include poor projection, tip ptosis, asymmetry, and widening 2
• Alar Collapse - Results from overreduction of tip elements 3

Functional Complications

• Nasal Obstruction - Reported in up to 70% of revision rhinoplasty patients 2
• Olfactory Disturbances - Temporary or permanent changes in sense of smell 4
• Mucus Recirculation - Occurs when mucus draining through a sinus ostium re-enters the maxillary sinus through a different ostium 4

Risk Factors for Complications

• Age ≥40 years - Independent risk factor with relative risk of 2.05 for major complications 1
• Combined Procedures - Complications increase from 0.58% in rhinoplasty alone to 1.02% with one additional procedure and 2.09% with two additional procedures 1
• Smoking - Increases risk of wound dehiscence and healing problems 4
• Previous Nasal Surgery - Increases technical difficulty and complication risk 4

Prevention Strategies

• Proper Patient Selection - Consider psychological factors and realistic expectations 2
• Preservation of Critical Support Structures - Particularly the caudal septum to maintain tip and columella position 2
• Meticulous Surgical Technique - Careful osteotomies and tissue handling to minimize trauma 5
• Appropriate Postoperative Care - Including head elevation, cold compresses, and careful follow-up 3
• Prophylactic Antibiotics - Consider in selected cases to prevent infection 3

Management of Complications

• Bleeding - Most occurs within 72 hours or around 10 days postoperatively; may require packing, cautery, or rarely surgical intervention 3
• Infection - Prompt antibiotic therapy; for sinus infections consider amoxicillin/clavulanic acid with metronidazole or levofloxacin 4
• Synechiae - May require in-office lysis or revision surgery 4
• Aesthetic Deformities - Often require revision rhinoplasty, which occurs in 5-15% of cases 2

Rhinoplasty remains a challenging procedure with a significant learning curve. Complications decrease with increasing surgical experience, but even experienced surgeons encounter them. Thorough preoperative counseling, meticulous surgical technique, and appropriate postoperative care are essential to minimize risks and optimize outcomes 2, 5.