Like by any surgery also during rhinoplasty there might occur complications by the actual procedure or in the period after the surgery. Some later problems can be caused by miskeeping the surgeon’s instructions.

Complications during the actual surgery

Damage of surrounding tissue during the actual procedure is preceded by gentle process and precise technique. There is used so-called cautery against bleeding. It is a thermal instrument that closes the bleeding vessels after the removal of tissue. By wrong use there might appear burned spots on the tissue that hinder the healing and that are aesthetically undesirable. By surgery after preceding trauma also surrounding tissues might be damaged. Those can be bleeding into the orbit that cause damages of vision and it must be treated in the cooperation with ophthalmologist. Another complication is damaged lacrimal gland. It can even lead via fistula into the nasal cavity.

Passed trauma can also threaten bone and cartilage structures that are modified during the surgery – recreation of already healed fracture. By osteotomy (surgical sectioning of bones) there might form different deformities. Among three main deformities we range so-called “Rocker” deformity, “Open Roof” deformity and “Step” deformity. The first forms when the cranial bone is broken during the nose surgery. Forming “Open roof “ deformity is caused by wrong straightening of the lateral segments with nasal septum. When neglecting the treatment there is the possibility of various holes on the affected side of nose. The last type of deformity is on contrary manifested by humps that must be corrected by another rhinoplasty surgery. Damage of skin eases the creation of undesired scar. The scars might be elevated and spread or contracted. None of the types is of course not desirable.

Some problems are caused by general patient’s disease. One of them is increased bleeding, which is usually caused by congenital disease (e.g. damage of blood coagulation), by associated disease (wrong liver function) or by pharmacological treatment. Therefore it is necessary to inform the surgeon about all drugs that you take. Bleeding can be increased even by common aspirin.

Immediately after the surgery threatens also breathing problems, anaphylactic shock (caused for example by given drugs during the surgery) or vision defects. All this is valid for any other surgery.

Early post-surgical complications of rhinoplasty

Most of the early post-surgical complications of rhinoplasty concern the wound itself. There threatens its infection (it is preceded with taking the antibiotics and draining), loosening of the stitches, bleeding and hematomas. The skin in the place of the wound and around it reacts by contact dermatitis (especially in sensitive patients), in worse cases (for example by more difficult procedures) also by necrosis. Necrosis is the death of tissue that must be removed, otherwise it is often complicated with infection.

Naturally after each procedure follows pain and swelling. None of these symptoms can remain too long though. In patients after rhinoplasty there have also been reported damages of smell or nose blockage that in many cases with following rehabilitation fade away themselves.

Dangerous are system complications. Because the breathing is limited, in people with heart problem threatens heart failure. Infection from the wound can also transfer into the body. Very risky is damage of brain. There might form inflammations of the meninges of the brain or abscesses directly in the nerve tissue but also thrombosis of venous sinus. Therefore by longer lasting headaches, sudden epilepsy or fever warn immediately your surgeon. Among other complications belong inflammations of heart valves (endocarditis). Dangerous situation for the patient’s life represent total sepsis and so-called toxic shock syndrome. It is caused by bacterial toxin in the blood and it’s symptoms can occur already soon after the surgery. The mortality rate is almost 11%. Infection complications appear especially in patients with weak immune system.

Thanks to previous traumas or infections there might sometimes occur leakage of the content from the nose. It is a cerebrospinal fluid because there has been communication with cranial cavity. This state must be also soon solved.

Late post-surgical complications of rhinoplasty

These rhinoplasty complications are associated with the area of nose as well with surrounding tissues. Beside deformities (drops, humps) there can occur also due to wrong healing so-called hypertrophic scar. It is described as a formation that arches above the scar. It is caused by increased production of ligament in the place of healing. Nose function is damaged by different post-surgical narrowing in the nasal cavity. It limits also the patient by worse breathing through the affected side. Usually the problem is solved by reconstruction procedure. The same like adhesions or perforations of nasal septum. Fat substances used during the surgery can cause inflammatory reaction in the place of application and form so-called oleogranuloma. It is mostly removed surgically from the affected tissue. Exceptions are not even cysts.

The surgical procedure is not always successful as the patient desires it to be. From many reasons in small percentage the original deformity is not successfully corrected, in worse cases it is emphasized or there forms a new deformity. It is necessary to wait for another surgery minimally a year from the first procedure. Depending on the placement there are deformities of upper, middle or lower third of nose. It is usually change of angle, widening or narrowing of the give part or asymmetry. In patient with implant it can be shifted or loosened. There might occur also changes in the tip of nose in case of one sided defect or asymmetry and again it is solved by surgical procedure. Problems that affect other areas except nose are complications with teeth. They are preceded with the cooperation of surgical team and stomatologist. Also secretion from the nose during meal, it is probably caused by defects of nerve structures by the surgery. Among other complications belong allergic reaction on the implant, damage of lacrimal glands (their damage or leakage of their content into the nasal cavity) or communication between cranial cavity and its surrounding, when the cerebrospinal fluid leaks from the nose. There is again a risk of meningitis.

Some sources state that patients-smokers are more endangered by the complications. This type of surgery is not even recommended to people that suffer from some system disease like for example diabetes mellitus.

Mental state and rhinoplasty

Psychic problems sometimes accompany the patient already from the time before the nose surgery. The fear from the procedure’s effect needs to be monitored immediately after the nose plastic surgery. Some patients are even depressive. Aggressiveness or anger can occur in patients that are unsatisfied with the result of the procedure. The reason does not have to be badly performed surgery but also exaggerated expectations of the patient. Although most of the patients are usually satisfied with the result of the rhinoplasty surgery and their mental state and quality of life is improved.

Updated: 2009-03-30

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