Complications of rhinoplasty

Rhinoplasty is a commonly known plastic surgery procedure to improve the appearance and function of the nose. The function of the nose relates to breathing. As in all surgical procedures, complications can happen. The goal of preoperative evaluation is also to seek out any potential problem. But despite the best efforts, complications can occur. 


The incidence of the complications varies. It can vary depending on the type of procedure, and patient factors. It is more common to have a greater incidence of complications in difficult (challenging) cases. Some of the complications are uncommon when compared to others. The complications can be seen under those that are nonspecific to rhinoplasty and those specific to rhinoplasty. 


The nonspecific complications can occur in any surgical procedure. It need not be in rhinoplasty alone. These include, 

• Infection: These are uncommon in rhinoplasty. But when they happen, they tend to be serious and can impair a surgical outcome. 
• Prominent scars: These are uncommon. However, more common would be a scarred appearance of a nose that has undergone multiple rhinoplasties. 
• Delayed healing

The specific complications of rhinoplasty are those related to aesthetic (appearance) and functional (breathing).


The aesthetic complications include, 

• Asymmetry: This could be a worsening of a pre-existing asymmetry. 
• Dissatisfaction with the appearance. This could be due to the appearance of the tip, dorsum, projection, width, base, and various other parts of the nose. It is a reason for revisionary or secondary corrections. 

Swelling is usual after rhinoplasty. The various layers of the nose are swollen. This includes the outer skin, lining mucosa, and the structures in between these two layers. Swelling subsides with time. Even though most of the swelling settles by a month, the residual swelling lasts longer. This can take about a year or longer to subside. Hence, any decision to undertake revisions is taken after this period.  


Functional problems associated with rhinoplasty include, 

• Difficulty with breathing. It is common to have difficulty in breathing during the initial weeks due to swelling of the inner lining of the nose. There would be an improvement in the breathing as the swelling subsides. So any evaluation for persistent difficulty in breathing is carried out after this period. 
• Septal perforations. The septum is the midline structure that separates the two sides. This can undergo perforations. This is more common in previously operated noses. Septal perforations of the posterior (back) and those that are asymptomatic are usually left alone. The symptomatic perforations can need revisionary procedures. 

Some of the complications are more serious when compared to others. Also, the difficulty level in performing a rhinoplasty can vary depending on the presentation. It is also more so in previously operated noses. It is not possible to eliminate the possibility of complications. However, it is usually possible to reduce their incidence with careful planning and attention to detail. 

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