Common Risks and Complications of Rhinoplasty: What to Know

So here’s the thing nobody really emphasizes when you’re sitting in that consultation chair, flipping through gorgeous before-and-after photos and mentally photoshopping your own face: sometimes stuff goes sideways.

I’m not talking about horror-story disasters (though we’ll get to the serious stuff). Most rhinoplasty procedures go fine—really, they do. But “fine” exists on a spectrum. Sometimes you heal beautifully and love your results. Sometimes there’s a complication that needs managing. Sometimes the outcome is… okay, but not what you pictured during those late-night research sessions.

The tricky part? Talking about risks feels like you’re jinxing yourself or obsessing over worst-case scenarios. Your surgeon mentions them quickly—you know, the legal stuff on those consent forms you initial seventeen times. You nod, sign, and everyone proceeds with fingers crossed that you’ll be in the majority who sail through recovery.

But here’s what I’ve learned: understanding what can actually go wrong (and how often, and why) doesn’t make you paranoid. It makes you prepared. It helps you choose a surgeon who’s genuinely experienced, not just charming. It means you’ll recognize warning signs early instead of wondering if that swelling is “normal” at 2 a.m. on a Saturday.

Look, rhinoplasty isn’t particularly dangerous. Life-threatening complications? Extremely rare. But minor issues, results that don’t quite match your vision, needing a second surgery to tweak things—that happens often enough that you’d better understand the full picture before permanently changing the most prominent feature on your face.

Let’s walk through what can actually happen, from the everyday stuff that nearly everyone experiences to the rare complications that keep surgeons up at night.

Table of Contents

Understanding Risk: General Complication Rates

Okay, let’s talk numbers. Because “safe” means different things to different people.

Overall Safety Profile

The good news first: rhinoplasty is generally safe. About 85-90% of patients heal without major drama and end up happy with their results. When you’re working with a board-certified plastic surgeon or facial plastic surgeon in an accredited facility, truly serious, life-threatening complications happen in less than 1% of cases.

But—and this is important—”safe” doesn’t mean complication-free. It means most problems are manageable, not that problems don’t happen.

Here’s a more realistic breakdown:

Minor stuff (swelling, bruising, temporary discomfort): Pretty much everyone gets this
Moderate issues (swelling that lingers, slight asymmetry, breathing changes): 10-20% of patients
Major complications that need actual intervention: 5-10%
Revision surgery needed: 10-15% of first-time rhinoplasties

Now, these percentages shift around depending on your surgeon’s experience, how complex your particular case is, your own health factors, and honestly, how we’re defining “complication” in the first place. But the takeaway? Most people do just fine. Problems aren’t exactly rare, though.

Factors Affecting Complication Risk

Your personal risk isn’t the same as the next person’s. It depends on a mix of factors, some you can control and some you can’t:

Surgeon stuff:

How experienced they are (specialists who do this all the time have way lower complication rates)
What techniques they use
How many rhinoplasties they actually perform each year (ask this directly—it matters)

Patient stuff (that’s you):

Whether you smoke (this one’s huge—smoking dramatically cranks up your risk)
Your age and overall health
Whether this is your first rodeo or a revision (second surgeries are trickier)
Your skin type—thick skin vs. thin skin behaves differently
Whether your expectations are reasonable or, let’s be honest, a bit unrealistic

Procedure stuff:

First-time rhinoplasty vs. fixing a previous surgery
How dramatic the changes you’re requesting are
Whether you’re fixing breathing issues or just want cosmetic changes
Open approach (external incision) vs. closed (all internal)

Once you understand these factors, you can get a better sense of where you fall on the risk spectrum.

Common Complications: What Happens Most Often

Some things happen so often after rhinoplasty that calling them “complications” feels like a stretch. They’re more like… inevitable features of recovery. But they can still surprise you if nobody’s been straight about what to expect.

Swelling and Bruising (Everyone Gets This)

If you get rhinoplasty, you will swell. Period. Your nose just got surgically rearranged—swelling is how your body responds. But what catches people off guard is how long it actually sticks around:

The swelling timeline (buckle up):

First 1-2 weeks: Obvious swelling that everyone can see
Weeks 2-12: Still swollen, though you’ll notice it more than other people will
Months 3-18: Subtle swelling, especially in your tip, that slowly fades

When swelling becomes an actual problem:

It’s uneven, making one side look different from the other
It goes on way longer than it should
It’s making it hard to breathe

Most swelling? Totally normal. Just your body doing its healing thing. But if it’s excessive or sticks around suspiciously long, that could signal something like infection or a hematoma that needs checking out.

Temporary Numbness (Very Common)

Here’s something weird that nobody really prepares you for: after rhinoplasty, parts of your face go numb. Your nose, your upper lip, sometimes even your front teeth. This happens to basically everyone because the surgery disrupts nerves.

What you’re in for:

Sensation usually comes back gradually over 3-12 months
Full feeling might take up to 18 months to return
In rare cases (1-2% of patients), some small spots stay numb permanently

Most people adapt fine. It’s just… odd. You might struggle with certain facial expressions early on, and drinking through a straw can feel bizarre when you can’t fully sense your upper lip.

Minor Asymmetry (Common)

Let’s be real: perfect symmetry doesn’t exist. Not in nature, not on anyone’s face, and definitely not as a guaranteed surgical outcome. So when minor asymmetries show up after rhinoplasty—one nostril slightly different from the other, a tip that leans a tiny bit left or right—it’s pretty common.

The types you might see:

One nostril shaped a bit differently than the other
A slight tip deviation
Bridge contours that aren’t perfectly mirrored
Swelling that’s uneven and makes things look asymmetric temporarily

When it actually matters:

People notice it in regular conversation (not just you obsessing in the mirror at weird angles)
It genuinely bothers you
It’s clearly a surgical mistake, not just natural facial variation

The tricky part? Deciding what counts as “normal minor asymmetry” versus “this needs to be fixed” is super subjective. Patients and surgeons sometimes see this very differently, which can get… tense.

Breathing Changes (10-20% of Patients)

Even if you’re getting rhinoplasty purely for looks, your breathing might change afterward. It’s one of those things that sneaks up on people.

Temporary breathing issues (these usually resolve):

Internal swelling blocking your airways
Crusting or dried blood clogging things up
Swelling of your turbinates (those structures inside your nose that warm and filter air)

Breathing problems that stick around:

Internal valves that got narrowed (this is the most common functional issue)
A deviated septum that surgery created or made worse
Enlarged turbinates
Scar tissue forming and blocking airflow

Here’s the concerning stat: about 5-10% of patients end up with breathing problems that don’t go away on their own and need another procedure to fix. This is one of the more serious complications because, you know, breathing is kind of important. It’s also one of the top reasons people go back for revision surgery.

Moderate Complications: Less Common But Significant

Now we’re getting into stuff that doesn’t happen to most people, but when it does happen, it’s a bigger deal.

Infection (1-3% of Cases)

Thanks to preventive antibiotics, infections after rhinoplasty aren’t super common. But they’re not unheard of either:

Early infection (first few days to weeks):

Your pain gets worse instead of better—that’s a red flag
Fever over 101°F (38.3°C)
Drainage that looks like pus (gross, but important to watch for)
Redness, warmth, and swelling that’s increasing

Late infection (weeks or even months later):

Sometimes tied to foreign materials like implants or grafts your body’s rejecting
Might show up as chronic inflammation that doesn’t look like a classic infection

How it’s treated:

Antibiotics, either pills or IV depending on severity
Maybe surgical drainage if an abscess forms
In bad cases, removing infected grafts or implants

The good news? Most infections clear up well with antibiotics if you catch them early. The trick is knowing what warning signs to look for and not waiting to contact your surgeon.

Hematoma and Seroma (2-5% of Cases)

Sometimes blood (that’s a hematoma) or clear fluid (that’s a seroma) pools up under your skin or inside your nose. When that happens, you’ve got a problem that needs addressing.

What it looks like:

One area gets excessively swollen
Discoloration appears
You feel pressure there
Sometimes you can actually see a fluid pocket

What happens if it’s left untreated:

It can get infected
The pressure damages tissue
Healing goes poorly and you get scarring
If it’s in your septum specifically, the cartilage can get damaged

How to fix it:

Drainage procedures (not fun, but necessary)
Pressure dressings
Sometimes you need surgical evacuation

Here’s where it gets serious: septal hematomas (blood collecting in the wall between your nostrils) need urgent drainage. Like, don’t-wait-until-Monday urgent. Otherwise the cartilage can die, and that causes permanent structural damage.

Unsatisfactory Aesthetic Results (10-15%)

This is probably the most frustrating “complication”—medically, your nose heals just fine. But you look in the mirror and think, “This isn’t what I wanted.”

What people typically wish was different:

There’s still a bump on the bridge
The tip isn’t refined enough (or it got over-refined and looks pinched)
The nostrils don’t match
The profile just… doesn’t look how you pictured it
The change is too subtle—or way too dramatic

The messy part: Figuring out whether this is a surgical mistake, normal healing (remember, swelling can stick around for 12-18 months), expectations that weren’t realistic from the start, or just subjective taste—that’s genuinely hard. And it can lead to some uncomfortable conversations between patients and surgeons.

I’ve heard from people who loved their results at six months and then felt differently at a year. I’ve heard from others who panicked at three months and ended up thrilled at the one-year mark. Timing matters.

About 10-15% of first-time rhinoplasty patients end up getting revision surgery. Sometimes it’s to fix actual technical issues. Sometimes it’s to refine things further. Sometimes it’s because what they expected wasn’t actually achievable with their anatomy.

Scarring Issues (Variable)

Scarring is always a possibility with surgery, though how visible it ends up being varies a lot.

External scarring (from open rhinoplasty):

That columellar incision (between your nostrils) usually heals really well and becomes barely noticeable
Once in a while, you get hypertrophic scars (raised) or scars that widen
This is more common if you have darker skin or a history of keloid scarring

Internal scarring:

Can block airflow and make breathing harder
Might create adhesions where tissue sticks together in ways it shouldn’t
Sometimes needs revision surgery to fix

Alar base scars (if they narrowed your nostrils):

Usually heal just fine
Occasionally they stay visible or get wider

Most scarring ends up being minimal—nothing you’d really notice unless you were looking for it. But when scars do become problematic, treating them with steroid injections, laser therapy, or revision surgery is an option.

Serious Complications: Rare But Important

Okay, now we’re talking about the stuff that’s uncommon but genuinely serious when it does happen. These are the complications that make surgeons lose sleep.

Septal Perforation (Less Than 1%)

A hole punched through your nasal septum—that wall between your nostrils—is one of the more troublesome things that can go wrong.

What causes it:

Taking out too much cartilage during surgery
Injuring the lining on both sides of your septum
Infection that eats through tissue
A septal hematoma that wasn’t drained
Blood supply getting compromised

How you’d know you have one:

A whistling sound when you breathe (distinctive and annoying)
Constant crusting and occasional bleeding
Your nose feels blocked
Sometimes, if the hole’s small, you might not even notice

Can it be fixed?

Small perforations? Sometimes they don’t even need treatment
Surgical repair is possible but difficult—and honestly, it often doesn’t work
Prosthetic devices called septal buttons can help

This is one where prevention through careful surgical technique is everything, because fixing it after the fact is a real challenge.

Skin Necrosis (Very Rare, Under 1%)

This is the nightmare scenario: skin on your nose actually dies because the blood supply got cut off. It’s rare, thank goodness, but when it happens, it’s devastating.

What puts you at risk:

Smoking (this dramatically shoots your risk up—like, dramatically)
Cocaine use
Previous nasal surgeries where a lot of tissue was separated from underlying structures
Injection rhinoplasty that compromised blood vessels
A surgeon thinning the skin too aggressively

What happens if you get it:

You lose tissue that needs reconstructing
Significant scarring
You might need skin grafts or flaps to repair the damage

This is THE reason surgeons are so intense about the no-smoking rule before surgery. It’s not them being controlling—it’s about preventing your skin from dying.

Nasal Collapse or Structural Problems

Here’s what can happen when a surgeon removes too much of the structural framework that holds your nose up:

Saddle nose deformity: Your bridge collapses inward, creating a concave, scooped-out profile

Tip collapse: Not enough support, so your tip droops or looks pinched

Valve collapse: The internal structures cave in when you breathe, blocking airflow

Think of your nose like a tent—take away too many support poles, and the whole thing sags. Fixing these structural issues usually means complex revision surgery where cartilage grafts (often harvested from your rib or ear) get used to rebuild the framework.

Severe Bleeding

Bleeding happens with any surgery, but severe bleeding is another story.

During surgery:

Your surgeon controls it as they go
Transfusions are rarely needed
Sometimes heavy bleeding forces the surgeon to wrap things up faster or scale back what they planned to do

After surgery:

Most post-op bleeding is minor—annoying but manageable
Severe bleeding that requires going back to the OR? Less than 1% of cases
Your risk goes up if you’re on blood thinners, have uncontrolled high blood pressure, or can’t resist picking at your nose

When to worry about bleeding:

Bright red blood flowing continuously for more than 20 minutes
You’re passing large blood clots
Blood is making it hard to breathe
You feel dizzy or weak

If you’ve got severe bleeding, don’t wait—get immediate medical help.

Anesthesia Complications

Let’s not forget that general anesthesia itself comes with risks that have nothing to do with the actual nose surgery:

Adverse reactions to the anesthetic drugs (allergic reactions, for instance)
Nausea and vomiting afterward (common and usually just an annoying few hours)
Aspiration, where stomach contents get into your lungs (rare but serious)
Heart or breathing complications (very rare if you’re otherwise healthy)

Good preoperative screening and working with board-certified anesthesiologists keeps these risks as low as possible.

Special Considerations: Revision Rhinoplasty Risks

If you’re going back for a second (or third) rhinoplasty, you should know: revision surgeries are significantly riskier than first-time procedures.

Why it’s harder and riskier:

Scar tissue obscures the anatomy—your surgeon’s working somewhat blind
There’s less cartilage left to work with for grafting
Blood supply might already be compromised from the first surgery
Your skin has less elasticity and doesn’t drape as nicely
The whole operation is just technically more challenging

The numbers for revision rhinoplasty:

Overall complications: 15-25% (compared to 10-15% for first-timers)
Breathing problems: 15-20%
Needing yet another revision: 20-30%

Here’s the frustrating truth: each subsequent revision gets more complicated, with worse odds and higher risks. There’s a point of diminishing returns.

Risk Reduction: How to Minimize Complications

No surgery is completely risk-free, but you’re not powerless here. There’s a lot you can do to tilt the odds in your favor.

Choose Your Surgeon Carefully

This is the big one. Like, the BIGGEST one.

Credentials that actually matter:

Board certification in plastic surgery or facial plastic surgery (not just “cosmetic surgery”)
Significant rhinoplasty-specific experience—ask directly how many they do per year
Hospital privileges, which means they’ve been credentialed and reviewed by peers
An accredited surgical facility (not someone’s office “procedure room”)

Red flags to run from:

Prices that seem way too good to be true (they are)
Pressure tactics or trying to rush you into a decision
Dodging questions about risks or getting defensive about complications
Limited rhinoplasty experience but lots of confidence

Your surgeon choice is hands-down the single most important factor in whether you’ll have complications. Everything else is secondary.

Follow Pre-Operative Instructions Meticulously

Your surgeon gives you instructions for a reason. Patients who actually follow them have way lower complication rates.

The non-negotiables:

Stop smoking at least 4 weeks before and after surgery (seriously, not “cutting back”—stopping)
No blood thinners or certain medications (aspirin, ibuprofen, many herbal supplements)
Get your chronic conditions under control—diabetes, high blood pressure, whatever you’re managing
Have honest conversations about realistic goals before surgery, not after

I know it seems like overkill, but these instructions exist because not following them causes problems.

Recognize and Report Warning Signs Early

Knowing when something’s actually wrong versus just normal healing can prevent small issues from snowballing.

Call your surgeon if you notice:

Fever above 101°F (38.3°C)
Pain that’s getting worse instead of better
Bleeding that’s more than just minor spotting
Signs of infection (pus, increasing redness and warmth, that kind of thing)
Breathing trouble that goes beyond typical post-surgical congestion
Any changes to your vision (super rare but serious enough to warrant immediate attention)

Catching problems early often means the difference between “took antibiotics for a week” and “needed another surgery.”

Have Realistic Expectations

A lot of “complications” aren’t medical at all—they’re expectations that didn’t match reality.

What you need to understand going in:

Perfect symmetry isn’t achievable. Not in nature, not surgically.
Your result will suit your face, not look exactly like that celebrity’s nose you saved on Pinterest
Subtle changes often work better than dramatic transformations
Full healing takes 12-18 months. You need patience.
Minor imperfections are part of being human

Managing your expectations isn’t about lowering them—it’s about aligning them with what’s actually possible given your anatomy. This prevents the psychological “complication” of crushing disappointment.

When Complications Occur: What Happens Next

So let’s say something does go wrong. What then?

For immediate medical issues (infection, bleeding, hematoma):

Get in touch with your surgeon right away—don’t wait
You might need an office visit, medications, or in rare cases, a trip back to the OR
Most of these resolve well if treated promptly

For aesthetic issues:

Give it time. Don’t judge your final results until you’re at least 12 months out
Be honest with your surgeon about your concerns—they can’t read your mind
They might offer minor revisions (small tweaks under local anesthesia)
Major revisions usually wait until 12-18 months when everything’s fully healed and settled

For breathing problems that stick around:

Functional testing can pinpoint exactly what’s causing the obstruction
Revision surgery might be needed to fix it
Sometimes non-surgical options like nasal dilators or sprays provide enough relief

About getting second opinions:

Totally appropriate if you’re not happy with your results or how your surgeon’s communicating
Really helpful when planning complex revisions
Just remember: realistic expectations still apply, even with a new surgeon

The Bottom Line on Rhinoplasty Risks

So here’s where we land: rhinoplasty is generally safe, but it’s not risk-free. Most complications you’d encounter are minor and manageable. The really serious stuff is rare. But disappointing results? Breathing issues that persist? Needing a second surgery? Those happen often enough that you’d better go in understanding they’re real possibilities.

Most people—the majority—heal without drama and end up happy with their results. That’s genuinely the most common outcome. But it’s not guaranteed. And if you’re going to permanently change your face, you should know what might go sideways.

The practical takeaways: choose your surgeon like your results depend on it (because they do). Follow every single instruction they give you, even the ones that seem excessive. Keep your expectations grounded in reality, not Instagram filters. And if something does go wrong, speak up early.

Rhinoplasty can genuinely improve how you look and how you breathe—when it goes well, it’s transformative. But it’s still surgery. There’s cutting, there’s healing, and there are risks that come baked into the process, no matter how skilled your surgeon is.

Going in with your eyes wide open means you won’t be blindsided if you hit a complication. You’ll catch problems early. You’ll make better decisions. And whether your journey is smooth or includes a few unexpected detours, you’ll handle it better because you knew the full landscape from the start.

Common Risks and Complications of Rhinoplasty: What You Actually Need to Know