Long-term Nose Bleeds Many Years After Rhinoplasty

I've had 2 rhinoplasty surgeries. First one healed and the cartilage was pronounced on the tip and looked "done" and my nose bled and scabbed. 2nd revision a few years after the first made my nose look natural but I still have a scab that bleeds. I've tried saline sprays, neti pots and Polysporin in the nostril. It's been about 8 years and my nostril scab won't heal and i still bleed, every day. I've seen an ENT years ago and he said it's probably my airway is so large that it dries out and never heals. Any suggestions?

Doctor Answers 28

Bleeding After Rhinoplasty Needs Evaluation

There are numerous potentially treatable causes of persistent scabbing after Rhinoplasty, like a foreign body (e.g. a stitch), a bone or cartilage fragment, infected cartilage or bone, a septal perforation, or even dryness and picking fingers.

Most importantly, you should seek evaluation and treatment to resolution.

Denver Plastic Surgeon
4.6 out of 5 stars 39 reviews

Long-term bleeding after rhinoplasty: You need a thorough evaluation.

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.

Anand D. Patel, MD
Brookfield Facial Plastic Surgeon
5.0 out of 5 stars 19 reviews

Nosebleeds have many causes

The potential problems that can lead to recurrent nosebleeds (epistaxis) are numerous.  Common conditions include dryness, septal deviations, local irritation.  This problem may not be related to the previous surgery.  A competent Otolaryngologist-head and neck surgeon should evaluate your problem, and give you some advice.

Robert Mounsey, MD
Toronto Facial Plastic Surgeon
4.7 out of 5 stars 11 reviews

Saline gel for nose bleeds.

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.

Steven Goldman, MD
Cleveland Plastic Surgeon
5.0 out of 5 stars 142 reviews

Chronioc bleeding after rhinoplasty

There are so many potential causes for nasal bleeding years after rhinoplasty including thinned nasal lining, dry environments, retained permaneent sutures, small septal perforations, to name a few.  A thorough exam is important.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Frequent nose bleeds

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.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Chronic nosebleeds after rhinoplasty

Nosebleeds years after rhinoplasty probably are due to a thinned, atrophic nasal lining that cracks and bleeds.  If moisturizing doesn't work, then you may consider surgery to control the bleeding either through cautery (I prefer bipolar cautery for this) or by replacing the thinned lining with more lining.  This can be done by a skilled experienced surgeon with knowledge of septal perforation repair. 

Minas Constantinides, MD
Austin Facial Plastic Surgeon
3.9 out of 5 stars 7 reviews

Chronic scabbing and bleeding after Rhinoplasty

If this problem only appeared after you had nasal surgery then a thorough nasal exam should reveal the problem. Is the crusting and bleeding always located in the same spot - then look for retained permanent suture or partially exposed cartilage. Is it on the turbinate or the septum? Then look for prominences that dry out and lead to crusting and bleeding. Is it you? Sometimes chronic manipulation and trauma to the internal nose can cause the same symptoms. Bottom line - find an experienced nasal surgeon who can spend the time to make a diagnosis.

Jon F. Harrell, DO, FACS
Miami Plastic Surgeon
4.9 out of 5 stars 49 reviews

Bleeding following rhinoplasty

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. 

Jason Hess, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 11 reviews

Bleeding after revision rhinoplasty

Whenever a patient says that they are having bleeding long after a rhinoplasty, it can send up red flags.  There a few very common reasons, and some uncommon reasons for bleeding.  The most likely scenario is as follows.  The lining of your nose is very much like your lips.  We all know that our lips can chap and bleed in dry weather.  Similarly if there is a knuckle of cartilage sticking out or a prominent vessel, this area can dry out and bleed.  The solution to this problem is a combo of nasal saline sprays to moisturize the lining of the nose.  An addition to this is Aquaphor to also moisturize the lining of the nose.  DO not use vaseline.

This is the most likely cause.

The chronic crusting is somewhat worrisome.  This could indicate a chronic inflammatory condition or an underlying septal perforation.  I would definitely see an ENT for a diagnostic endoscopy.

Raghu Athre, MD
Houston Facial Plastic Surgeon
4.6 out of 5 stars 89 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.