Rhinoplasty risks and complications: what can go wrong and how to lower the risk

Serious complications are uncommon. More often patients face smaller issues: swelling that lasts longer than expected, a minor irregularity or a temporary change in breathing. Most of these settle with time or can be managed without another operation.

It helps to think about risks in three groups:

• General surgical risks, such as bleeding, infection or a reaction to anaesthesia.
• Functional problems, when the nose works worse than before, most often with breathing.
• Aesthetic problems, when the shape does not match the plan or looks uneven once healed.

Swelling of the tip can take many months to settle, especially with thicker skin. The final shape is usually judged only after a year or longer, so early impressions are not a reliable guide.

• Breathing difficulty that persists after swelling has gone. It can be linked to a deviated septum, narrowing of the nasal valve or scar tissue inside the nose.
• Septal perforation, a small hole in the septum, which may cause whistling, crusting or nosebleeds.
• Changes in sense of smell, usually temporary.

Aesthetic complications

• asymmetry of the bridge, tip or nostrils;
• a remaining or new hump, or a bridge that looks scooped because too much was removed;
• a tip that droops, looks pinched or is turned up too far;
• small bumps or edges visible under thin skin;
• a thick or noticeable scar, more likely in people prone to keloids.

There is also dissatisfaction with a technically good result. It is more common when expectations were unrealistic or the goal was never clearly agreed.

• Health and habits. Smoking slows healing, and some medicines and supplements affect blood clotting. Uncontrolled chronic illness raises the risk of surgery in general.
• Aftercare. A knock to the nose, glasses resting on the bridge too early, heavy exercise or a hot sauna can all cause bleeding or displacement.
• Individual healing. Some people form more scar tissue or swell more, and this cannot always be predicted.

• Thick, oily skin hides small irregularities but also softens definition. Swelling in the tip lasts longer, and very fine detail may be hard to achieve.
• Thin skin shows definition well, but also reveals every small edge or bump, so the surgeon has to smooth the framework very carefully.
• Skin after previous surgery may be scarred and less elastic, which makes the result harder to predict.

A surgeon assesses skin quality at the consultation and adjusts the plan and expectations accordingly.

• Choose a surgeon who specialises in nose surgery and discuss your goals openly.
• Complete the full set of tests, including a scan of the sinuses and an ECG, and tell the doctor about every illness and medicine.
• Stop smoking and alcohol in advance, and agree with your doctor which medicines affecting clotting to pause.
• Avoid peels and other procedures that damage the skin of the face shortly before surgery.

After surgery

• Do not remove the splints or cast yourself and do not touch or blow your nose forcefully.
• Sleep on your back with your head raised, and avoid glasses on the bridge until the surgeon allows it.
• Avoid sport, saunas, hot baths and strong sun for at least a month.
• Keep every follow-up visit, so that small deviations are noticed early.

The first consultation is free and can be held online. Send photos of your nose from several angles and tell the coordinator about your health. The surgeon assesses your anatomy and skin, explains the realistic risks in your case and names the cost, which is fixed in the contract. After surgery, check-ups are planned at 7 days, 3 and 6 months. A personal coordinator stays with you from the first message to the end of recovery, and photos and questions can be sent by Telegram. More details are on the rhinoplasty page.