Risks and Possible Complications
Serious complications from rhinoplasty surgery are very rare. When they do occur, they are usually related to general anesthesia. Therefore, it is very important to have a discussion with your surgeon regarding the type of anesthesia that will be used during your rhinoplasty surgery (see Anesthesia).
The following is a description of risks and possible complications you need to be aware of prior to proceeding with surgery. However, this should not be considered a substitute to a thorough and open discussion with your surgeon. As with any other surgical procedure, any potential risks are greatly minimized in the hands of experienced and skilled rhinoplasty surgeons. This is one more reason to select your surgeon carefully (see Select your surgeon).
Bleeding and Infection
Bleeding and infection are risks associated with any surgical procedure. These risks are rare in rhinoplasty.
Bleeding can occur immediately following surgery or several days later. If it occurs in the immediate setting, it can be easily controlled. Bleeding that occurs several days after surgery is usually transient and stops spontaneously. However, there are rare instances where bleeding can persist and require the attention of your doctor. Factors that increase the chances of bleeding after surgery are high blood pressure, blood-thinning medications such as aspirin or ibuprofen (acetamenophen does not have a blood-thinning effect), a genetic predisposition, or a bleeding disorder. Proper pre-operative questioning and preparation should identify these factors. Another important cause of bleeding post-operatively is physical exertion during the first few days after surgery. During this period, the wounds inside the nose are not completely healed. Therefore, a rise in blood pressure can cause bleeding through these wounds. This can occur as a result of nose blowing, heavy lifting, vigorous exercise, or any other strenuous activity.
Infection is also very rare following nasal surgery. Some surgeons prescribe an antibiotic after surgery as a preventive measure, though this is not universal. In the rare instance where an infection arises, it is easily treated with antibiotics. Factors that increase the risk of an infection are a pre-existing infection in the nose, diabetes, or other illnesses that weaken the immune system. In addition, an implant in the nose made of foreign material slightly raises the risk of infection. In the event of an infection after surgery, the implant would need to be removed and antibiotic treatment given. This is one of the principal problems with implants placed in the nose and is one of the reasons that many surgeons avoid them.
Nasal Obstruction (Difficulty Breathing, Blocked Nose)
Nasal obstruction that arises after surgery can result from a weakening of the structures that support the nose and maintain the nasal passages open. This weakening can occur if the surgeon removes too much cartilage from certain critical areas or does not recognize certain weak areas and reinforce them. This type of nasal obstruction can occur immediately after surgery or more typically as a delayed symptom, a few weeks or months later. Such complications can be avoided if you have a surgeon who is knowledgeable in both the functional needs of the nose and in its esthetic considerations.
Nasal obstruction can be present prior to surgery and is often due to a deviation in the nasal septum (the partition between the two sides of the nose) or overgrown and enlarged turbinates (structures that are normally present in the nose and help with nasal airflow). These issues can usually be addressed at the same time as a rhinoplasty, if the surgeon is trained in such procedures (see select your surgeon). Although improved nasal breathing is usually achieved in experienced hands, there is still a small chance of failure. A second procedure would then be required to address the nasal blockage.
Perforation of the Nasal Septum
A septal perforation is essentially a hole in the nasal septum, the wall separating the two sides of the nose. It is therefore not a factor in patients undergoing only cosmetic rhinoplasty without any surgery on the nasal septum. This perforation can arise during surgery on the nasal septum and is not a factor in patients who undergo rhinoplasty without septoplasty. Although it is uncommon in the hands of an experienced surgeon, it may occur in certain cases of severe deformity in the nasal septum or if the patient has frail tissues due to other illnesses. A septal perforation may not cause any symptoms and therefore require no treatment, or it may be associated with crust formation, a sensation of nasal obstruction, or in severe cases, a cosmetic deformity.
Poor Esthetic Result
Any esthetic surgery carries the risk of a result that does not meet the patient’s expectations. This may be due to two factors: the surgical result itself may be suboptimal because the surgery was unsuccessful, or the changes and modifications performed on the nose were successful but may not have been what the patient expected. Prevention of the first is accomplished by choosing your surgeon carefully (see select your surgeon), while avoidance of the second results from good dialogue and communication with your surgeon (see consultation process). Make sure your surgeon shares your view of what would make your nose esthetically pleasing.
How Do I Avoid and Prevent Complications?
Although complications in rhinoplasty are uncommon, they can be further minimized. Selecting a skilled surgeon with expertise in facial esthetic procedures is the first step. In addition, it is important to ask about the staff working with the surgeon to make sure they are also experienced in this type of procedure. This includes the anesthesia doctor if a general anesthetic is used, and the nursing staff. Whether the surgeon is operating in a hospital or a surgical facility, make sure the environment is safe. Surgery performed in accredited surgical centers can be just as safe as a hospital, and may offer some additional advantages in that staff working there acquire significant experience in the specific procedures performed. Finally, be prepared and motivated to play your part in optimizing your outcome by educating yourself about the procedure and following the pre-operative and post-operative instructions provided by your surgeon.
Dr. Samaha’s extensive experience in nasal surgery of all types helps him minimize complications. Other factors that avoid surgical complications include our accredited center, our experienced staff and the avoidance of general anesthesia. All these factors ensure that risks of surgery are minimized to provide maximum safety.