Rhinoplasty, commonly called a “nose job”, is a cosmetic surgery procedure that deals specifically in reconstruction of the nose. This process can be done for purely cosmetic reasons or it could be done to correct a nasal defect. Most often during a rhinoplasty procedure, a cosmetic surgeon will not only correct any defects, but will also work to bring symmetry to the nasal passages and external appearance of the nose.
Dr. Paul Nassif Talks About Some of the Risks of Rhinoplasty
With rhinoplasty you are typically sent home right after the procedure is completed. This leads many into thinking that there will be no complications and, it’s true, the surgery is considered fairly safe when performed by an experienced plastic surgeon, but just like with any surgical procedure, there are several risks and complications that can arise. Some of these issues are simple and will clear up on their own, but that isn’t true for all the risks. Permanent damage, disfiguration, and even death are all possible when undergoing rhinoplasty procedures. The more serious risks are rare, but it is important to know all of them before making the decision that the surgery is right for you.
The most typical issues from a rhinoplasty surgical procedure are some of the same issues that would be present after any surgery. For example:
- Bleeding: Post-operative bleeding is typical and often clears up without further treatment being needed.
- Difficulty Breathing: Immediately after surgery breathing through the nose will be impossible because the nasal passages will be packed. This can cause discomfort. Breathing can be altered after surgery and may never improve. Blowing the nose is not recommended for many weeks after surgery as this can lead to damage of the newly constructed nose.
- Infection: Although rare, it is not all that uncommon for incisions from surgery to become infected. Most often this is taken care of with an antibiotic after surgery, but if the infection gets worse it can lead to more serious issues. Because of the work in the nasal passage a sinus infection can also develop. This is not usually serious, but it can cause discomfort, especially because blowing the nose is not possible.
- Black Eyes: Most patients have swelling and bruising around the surgery site and this can look like two black eyes. This most often clears up within a week or so after the surgery.
- Swelling: Most patients will have a fair amount of swelling. Typically this is not a serious issue; just uncomfortable. Swelling tends to go down within a couple of weeks, but it can take up to a year for the nose to ‘settle’ and all swelling to stop completely, although you should see about a 75% reduction or more within the first 6 months.
- Burst Blood Vessels: Along with the swelling and bruising, blood vessels right under the skin can also burst from the procedure. This is temporary, but will cause redness and red spotting around the nose and eyes.
There are also several medical issues that could cause permanent damage or death. These complications are much rarer, but it is still important to be well advised before signing up for a rhinoplasty procedure without knowing all the possibilities.
With any surgical procedure one area that is prone to causing complications is in relation to anesthesia. Rhinoplasty is done, most often, under a general anesthesia. While under a general anesthetic there is a risk of airway blockage. This would cut off your oxygen supply and could lead to fluid gathering in your lungs and/or respiratory arrest.
Complications connected to anesthesia can also lead to heart attack and a drop in blood pressure. In fact, most of the more serious issues connected to anesthesia are related to lung and heart attacks. These are very rare, but possible any time you are under a general anesthetic.
If you smoke, have diabetes, heart problems, or asthma your risk from general anesthesia increases. There are also several medications, vitamins, and herbal supplements, that can interfere with anesthesia, so it is important to inform your surgeon and anesthesiologist of anything that you are taking and give an honest and complete medical history.
Some of the more serious and permanent risks that come from rhinoplasty procedures are as follows:
- Losing Sense of Smell – Most often this is temporary and scent is recovered in the first week of healing, but in more serious cases loss of scent can be a permanent issue.
- Scar Tissue – Scarring can interfere in many different ways.
- Scarring inside of the nose can lead to obstructed nasal passages, which can sometimes require more surgery to correct.
- Scarring can also cause whistling while breathing, which isn’t dangerous, but it can be annoying or embarrassing.
- In an open rhinoplasty procedure scarring can also happen outside of the nose where the incisions are made. Typically these scars are small and unnoticeable, but it they don’t heal correctly they could become large or even turn into keloid scars. It is also not that uncommon for the scar to be noticeable for several months until healing is complete.
- Serious Infection – This is a rare issue, happening in less than 1 percent of procedures, but when left untreated an infection can lead to an abscess. This requires surgical intervention in the form of drainage. The intervention requires anesthesia to be performed, which adds another layer of complication.
- Perforated Septum – Surgery can cause the septum to be accidentally perforated, which leads to severe bleeding, problems with breathing, and a crusting of nasal fluids. This is a serious issue that requires further surgical intervention to correct.
- Deformities– This is more of an issue for people who have undergone several rhinoplasty surgeries, but can happen even in the first procedure. If there is too much of the nasal structure removed it can end up causing one of the following complications:
- Polly Beak: When too much of the framework is removed it can cause the skin to become shapeless. This looks much like the beak of a parrot, hence the term “polly beak”.
- Saddle Nose: If the septum is not strong enough it can cause a sinking in of the bridge of the nose.
- Porcine Nose: When the tip is over-rotated it can cause a pug-like or pig-like appearance.
- Pinched Nose: If the tip of the nose is reseated too much this can cause a pinched appearance in the tip of the nose.
- Nerve Damage – Nerve damage most often causes numbness in and around the face. In most cases this clear up on its own after a few weeks of surgery, but on rare occasions, the numbness can be permanent. This numbness can occur in the nose, in the areas under the eyes, and in the upper lip.
- Revision Rhinoplasty – If you are unhappy with your appearance, or if there were any complications during the procedure, this could lead to further surgical intervention. Revision surgeries are often higher risk and take longer to complete, and also quite a bit more expensive.
- Deep Vein Thrombosis (DVT) – This is a complication that happens when a blood clot is created inside of your body and restricts blood flow. It can cause discomfort and swelling, but if not caught early, it can lead to death.
- Skin Issues – There are several skin issues that can happen after a rhinoplasty surgery. Most often these are connected to contour or symmetry. Skin issues are often temporary and typically clear up during the healing process. More serious skin issues can be things like skin necrosis, when the skin dies and falls off or permanent discoloration or contour issues.
- Graft Problems – If there is a cartilage or bone graft done during your rhinoplasty, this can lead to issues with the graft staying in place. This is very rare, but a possibility.
- Toxic Shock Syndrome – This is extremely rare. The symptoms can include post surgical fever, vomiting, diarrhea, and a rash that feels like a sunburn.
- Depression – This complication can be related to not being happy with surgical outcome, but that isn’t always the case. Occasionally the nerve receptors can be damaged or shifted during surgery. If you notice unusual feelings of depression after your procedure it is important that you discuss this with your doctor.
Even with all of the risks and potential complications there is plenty that you can do to help minimize any problems. The first and most important step is to find the right doctor. Only use a board-certified plastic surgeon. Don’t be afraid to ask for before and after pictures of their previous work. It is better to find out that a surgeon doesn’t meet your needs before the procedure and not after.
Your doctor is going to give you the specifics on what they need, and expect, of you pre-operation. Make sure that you follow their rules and do what they ask. This is one of the best ways to prevent complications. Your doctor knows what they are doing. You picked them for a reason; now trust what they tell you.
Smoking cessation is one of the best things you can do for your health and this is especially true if you are going in for surgery. Smoking reduces your circulation and this can lead to serious complications during surgery. Smoking can also lead to slower recovery times and more complications post-op. The sooner you quit the better, but if you can stop at least four weeks before your surgery, this is best.
Issues around DVT are serious. One of the best ways to prevent this problem is to get up and walk as soon as you can after your surgery. Getting movement will help your blood flow and this is a simple and easy way to reduce risks associated with DVT.
Your doctor is going to tell you what to watch out for. Make sure you pay attention to their recommendations or get their directions in writing. Some of the signs of infections are things like elevated temperature, foul smells, deep redness, pain, and swelling. Taking your post-op medications as scheduled to help reduce the risk around infection. Don’t under, or over, medicate. Follow the directions exactly and you will lessen any possible side effects.
Out of all of the plastic surgery procedures, rhinoplasty has the highest number of revisions. Many who get a nose job are not really ready for the complete change that this procedure can have on the overall look of their face. This can lead to unhappiness with appearance and even depression.
With rhinoplasty it actually takes up to a year, and potentially more, for the nose to fully heal. If you don’t feel satisfied with the initial results you have to give it some time. Your new nose will continue to shift and change as healing takes place. It’s better to wait than to start a revision procedure, which is far more difficult and dangerous.