Long-term Nose Bleeds Many Years After Rhinoplasty

You need a thorough evaluation.

Here's some possible causes:

1) Autoimmune or vascular disorder:

Crusting/bleeding that is resistant to treatment may indicate conditions that fall under the heading of autoimmune or vasculitis. These conditions generally require a biopsy for diagnosis. It's better to find out sooner than later because they can cause problems in other parts of the body.

2) Septal perforation:

This is a hole in the mucous membrane that divides the two nasal passages. Unfortunately the most common cause is previous nasal surgery. The hole causes turbulence in nasal airflow which leads to excessive drying, followed by ulceration/bleeding/crusting.

3) Empty nose syndrome:

This is another condition that unfortunately is most common after previous surgery. Here, too much nasal tissue has been removed and this causes the airway to be too big. This also causes turbulence and the same effects outlined with septal perforations.

Fortunately, there may be medical or surgical solutions for these problems. Visit with a facial plastic surgeon or ENT for a thourough evaluation.

First, have a qualified otolaryngologist or plastic surgeon well versed in septoplasty and rhinoplasty evaluate your history and examine your nose. Nose bleeds often respond to saline nasal gel, over-the-counter salt-water-based gels for the nose. Use every night on both sides for at least two weeks. You can also use saline nasal spray 2-4 times a day. No picking. Have the doctor scope the inside of the nose (easy to do in the office) to look for a septal perforation or other issues. Hope this helps.

There are many potential etiologies of nose bleeds after Rhinoplasty.  Careful history and examination are the key to accurate diagnosis.  Some of the most prevalent causes include septal perforations (holes in the nasal septum) and thinning of the nasal lining.  Septal perforations require surgery to close the hole which prevents further crusting and bleeds.  Thinned nasal lining, secondary to multiple nasal surgeries, can dry out causing cracking and bleeding.  Moisture can be added to the lining in the form of saline gels and ointments.  Sometimes prominent blood vessels within the lining will require cauterization.

There are several potential reasons for why you may be bleeding. This can be an extensive evaluation and may even involve treatment of high blood pressure. Occasionally, it can be easily treated with cauterization and other times it may require ligation of vessels. I think its time you should be evaluated again to search for treatable causes.

Every time surgery is performed on the nose (whether primary or secondary) your normal tissue may be replaced by scar tissue.  Nasal blood vessels may be very close to the mucosal surface causing bleeding.  Additionally, if you underwent a turbinate resection, this impairs your nasal ability to humidify air upon inspiration.  This may cause mucosal bleeding and scabbing.  I would first return to your rhinoplasty surgeon.  He/she may be able to advise how to improve this outcome. 

  Bleeding after rhinoplasty can occur because of prominent blood vessels and or deflected septum.  The one thing that worries me is that you are also having crusting. I would suggest you get another evaluation and get a biopsy to make sure that you are not having an inflammatory problem and or fungal infections. While this is probably not the cause it is worth evaluating.

Bleeding after a rhinoplasty from many years ago has several potential causes including but not limited to:


prominent blood vessel

deviation of septum- turbulent airflow can cause areas of dryness which can create bleeding

septal perforation

thinned mucosal lining- dissection in wrong plane can lead to abnormal thinning of septal lining.

dry air- humidification of air and application of nasal lubricant can help

allergies or sinus- blood can be found tinged in mucous

ozena or atrophic rhinitis- removal of excessive mucosa from the nasal turbinates can lead to dryness and bleeding in the nasal airway

nasal trauma- a nice way of saying "nose picking".  the most common cause of nose bleeding overall.  after a rhinoplasty, in some cases the mucosa can lead to small portions where crusts can accumulate, which can lead to digital trauma.

hematologic condition- possible but unusual to develop a hematologic condition sponteanously


Bleeding from nose should be evaluated by thorough examination including history and at the very least an anterior rhinoscopy.

I suggest you obtain another consultation from another ENT. The most likely cause is small dilated vessles on your septum. However, a thorough examination should be performed before a diagnosis of " a large airway" is given.

It is abnormal to have frequent nose bleeds after a rhinoplasty.  If you did not have this problem before surgery, then a congenital nose bleeding disorder can be ruled out.  There are some other causes for a nose bleeds, such as excess dryness, retained permanent suture, abnormal cartilage nidus, other foreign body, abnormal musculature, etc.  Make sure you are examined by an experienced and expert nasal surgeon.  You might have had excess turbinate resection, might have large septal perforation, etc.  There is usually at least some relief possible in these cases with proper diagnosis and treatment.

Continued bleeding following prior nose surgery (rhinoplasty, revision rhinoplasty, and even septoplasty) should be evaluated by a nose specialist, particularly if it is this far out from surgery.

Simple explanations for something like this include a prominent blood vessel involving the inner lining of the nose (called the mucosa). The nose is richly supplied with blood, therefore, any bleeding can be quite dramatic. Conservative treatment for this type of issue includes topical ointments, moisturizers, humidification and avoidance of nose blowing. If this problem persists, it may be addressed with cauterization (either chemically or with an electrical device).

Other explanations for persistent nose bleeding after rhinoplasty include chronic scabbing over an exposed suture. In some rhinoplasty surgeries, permanent sutures are placed under the lining to stabilize shape and contour. If the overlying lining becomes too thin, the suture can be exposed. If this occurs, it is prone to scabbing over continuously. If the scab falls off, bleeding can occur. Despite use of ointments, moisturizers and humidification, this vicious cycle will continue in many cases until the suture is trimmed or cut out. 

There is another more severe and worrisome condition, called ozena, whereby the nose can continuously scab and bleed following nose surgery. This occurs when the surgeon removes too much of the turbinate, which is a natural structure running parallel to the septum inside of the nose. This is a dreaded complication of turbinate reduction surgery when an over aggressive approach is taken. Hopefully this is not the case with you as it is a very difficult problem to fix.