In the world of plastic surgery, rhinoplasty reigns supreme. According to the American Academy of Facial and Plastic Surgeons, it was the most performed facial procedure in 2021, surpassing facelifts and blepharoplasties. The American Society of Plastic Surgeons’ most recent findings show that it’s more popular than any other cosmetic surgery, on the face or body.
Given the popularity of the nose job, it’s reassuring to know that it’s generally fairly complication-free. While no cosmetic procedure is without some level of risk, rhinoplasties are extremely safe, says Dr. Dara Liotta, a board-certified facial plastic surgeon in New York City. In fact, a 2020 study found the incidence of major complications to be only 0.7%. As compared to other surgeries, “rhinoplasties are much quicker, you’re not putting in any type of foreign implant, there’s no large area being dissected, and the patient population tends to be much younger,” Dr. Liotta says. All of these things mean that the classic risks associated with plastic surgery—infection, anesthesia complications, bleeding—are lessened, she explains. In fact, most of the rhinoplasty-specific risks are really more annoyances than actual dangers, with one notable exception.
Ahead, top plastic surgeons explain the six most common rhinoplasty risks.
Rhinoplasty risk #1: nosebleeds, aka epistaxis
“When patients ask me about potential risks, this is the number one thing I talk about. It’s not common, but it is very dangerous, and the only real emergency complication I worry about,” says Dr. Liotta. This isn’t the same type of post-op bleeding that’s a concern with other surgeries; in those instances, you’re worried about bleeding into a closed space, causing something such as a hematoma, she notes. This is a full-on, gushing nosebleed that tends to happen 24 to 72 hours after surgery. While some bleeding afterward is normal and expected, this is excessive bleeding—we’re talking cups of blood—that doesn’t stop.
The doctors we spoke with cite the likelihood of this happening to be anywhere from 1% to 3%, but it’s very patient-dependent. Those with preexisting bleeding disorders, those who bruise or bleed easily, and those who take certain medications or supplements are at a higher risk of epistaxis, says Dr. Anil Shah, a board-certified facial plastic surgeon in Chicago. “I’ve been performing 5 to 15 nose jobs per week since 2012. In that time, I’ve had three patients experience serious nosebleeds, all of whom had an underlying bleeding disorder,” notes Dr. Liotta.
Should this occur, you need to seek medical attention immediately. Treatment depends on the severity; light to medium packing for one to four days is common, says Dr. Shah. On occasion, the patient may need to be anesthetized so that an endoscope can be inserted, to see where the bleeding is coming from, and heat cauterization may have to be used to stop it, Dr. Liotta adds.
Rhinoplasty risk #2: septal perforation
As the name suggests, this occurs when a hole develops in the septum after a septoplasty (which is often performed at the same time as a rhinoplasty), says New York City board-certified facial plastic surgeon Dr. Richard Westreich, who adds that studies show the incidence of this to be 1% to 5%. It’s rare that the hole is big enough to cause an issue, but if it is, it typically manifests three to six months after surgery, when patients start having trouble breathing, their nose is dry and crusty, or they start experiencing nosebleeds, says Dr. Liotta. A history of trauma to the nose, past surgeries, having a severely deviated septum, and intranasal drug use before or after surgery can all increase the likelihood of this happening, she adds. It can be fixed with a second surgery, although most perforations don’t require surgical intervention, Dr. Westreich says. Dr. Liotta agrees: “It’s not dangerous, it’s not a rapidly progressing issue, it’s more of an annoyance.”
Rhinoplasty risk #3: worsened breathing
Given that rhinoplasties are often paired with septoplasties, with the goal of improving breathing, having the opposite happen can be quite frustrating. One of the things doctors do during surgery is refine the width of the nose, and this narrows the nasal airway, which can impede breathing abilities, says Dr. Liotta. It’s more likely to happen in someone who was able to breathe well through their nose to begin with. If you have a deviated septum and couldn’t breathe well before surgery, fixing that typically outweighs any detriment that occurs from narrowing the airways, and it’s still a net improvement for the patient, she says. If it really is bothersome, another small surgery may be required, though sometimes there’s no way of fixing it.
Rhinoplasty risk #4: altered sense of smell or taste
“The likelihood of experiencing altered taste or smell after rhinoplasty is very rare—much less than 1%,” says Dr. Westreich. (Keep in mind that this doesn’t apply to the immediate post-op period, during which both will be impeded.) “It’s unlikely that in the long term someone’s sense of smell will be worse, though people do tell me that it changes after a nose job,” says Dr. Liotta. “There are no treatment options other than waiting for recovery, which can take anywhere from 6 to 12 months,” Dr. Westreich points out.
Rhinoplasty risk #5: skin discoloration
This is most likely to occur around the tip of the nose and the nostrils, manifesting as red skin or skin that has a bluish-purple cast, a result of damage to the blood vessels in the area. Again, it’s not super common and is much more likely to occur in people who have had multiple nose surgeries or who have a history of filler in the nose, says Dr. Liotta. “Every time you cut through that vascular supply during a surgery or even push on it with filler, you’re traumatizing and weakening those blood vessels,” she explains.
Unfortunately, there’s no way to fix this. And keep in mind that if you already have this type of discoloration and are seeking another rhinoplasty, your doctor may or may not be willing to do it. Damaging that blood supply even further can lead to the skin dying, or necrosis, which becomes a huge problem, says Dr. Liotta.
Rhinoplasty risk #6: the need for revision surgery
All the surgeons we spoke with were unanimous in underscoring this as one of the biggest potential “side effects” of a rhinoplasty, citing revision rates of anywhere from 5% to up to 30%. “The reasons for revision can be multifactorial,” says Dr. Shah. “It can be due to patient-surgeon miscommunication, challenging patient anatomy, or the surgeon’s inexperience with certain techniques applicable to that patient’s specific anatomy.” It’s also important to note that the likelihood of many of the other, aforementioned risks increases with each and every revision.
In order to minimize the likelihood of needing (or wanting) a revision, Dr. Liotta advises having an open dialogue with your surgeon about realistic goals and expectations as well as seeking out a surgeon who primarily performs or performs only rhinoplasties. “A surgeon who does two a month is going to have a different level of experience and a different arsenal of tools and techniques and learning from someone who does 10 per week,” she points out. “The nose is the only place on the body where micromillimeters matter, with no comparison to anywhere else.”
