Ask a doctor

What Should I Do About Complications After Rhinoplasty?

I had a Rhinoplasty procedure back on January last year and had to keep going back to my doctor for up to a year after since I was having breathing issues, a constant runny nose and still had some inflammation inside.

My doctor prescribed to me a couple different nasal sprays through the year and finally on January this year, he told me he was sorry and that he took too much cartilage out and would have to go back and do a graft of some sort to put cartilage back in to hold my nostrils up more since they were pinching shut when I inhaled.

He said he would take the cartilage out of the septum of my nose and it wouldn't be a problem. I had this done at the end of January this year since he offered to do it for free and I was hoping to finally breathe again.

After this 2nd surgery I don't think I will ever go under the knife again since it didn't make a difference as I am still sniffling and have a runny nose and don't feel like my breathing is better. Now I have this weird snore from a hole in my nose. Is there something else I can do to fix this breathing and runny nose issue? Is this normal or a doctor's error? I wish I had never done this and just wish I could breathe again. Tiff

Doctor Answers 7

Rhinoplasty complications

March 10th, 2009
{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Rhinoplasty is the most complicated surgery that we do. The surgery is only half of the issue--post operative convalescence and encouragement is the second.

The first surgery sounds like it was overdone resulting in a collapse (albeit mild) of the middle 1/3 of your nose. It may look good, but it makes it hard to breathe through your nose.

This problem was addressed in the second surgery with spreader grafts--cartilage from the septum that widens the middle 1/3rd to allow for easier breathing. It sounds like the harvest of the cartilage may have resulted in a septal perforation. The noise can also be the result of natural post-operative swelling. I routinely fix these problems for patients in my own area and often advise them that it takes 6-12 months for the swelling inside the nose to resolve before the breathing can improve.

So for you, I suggest patients if the spreader grafts were performed. However, if you have a septal perforation, you should seek out someone who can address the problem.

Robert M. Freund, MD
March 10th, 2009

Rhinoplasty complications

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Rhinoplasty is the most complicated surgery that we do. The surgery is only half of the issue--post operative convalescence and encouragement is the second.

The first surgery sounds like it was overdone resulting in a collapse (albeit mild) of the middle 1/3 of your nose. It may look good, but it makes it hard to breathe through your nose.

This problem was addressed in the second surgery with spreader grafts--cartilage from the septum that widens the middle 1/3rd to allow for easier breathing. It sounds like the harvest of the cartilage may have resulted in a septal perforation. The noise can also be the result of natural post-operative swelling. I routinely fix these problems for patients in my own area and often advise them that it takes 6-12 months for the swelling inside the nose to resolve before the breathing can improve.

So for you, I suggest patients if the spreader grafts were performed. However, if you have a septal perforation, you should seek out someone who can address the problem.

Robert M. Freund, MD

Breathing Complications After Rhinoplasty

March 10th, 2009
{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hi Tiff,

Sorry for your bad experience with your rhinoplasty. Even in the best of hands sometimes unsatisfactory results may occur. Your surgeon has tried his best to get a successful result.

It sounds (no pun intended) like you may now have a perforation (a hole) in your nasal septum which would account for the noise that you are describing. If there is a perforation, it is correctable but would require another surgery.

Your breathing may benefit from reducing the size of your inferior nasal turbinates. There is a non-invasive, non-surgical method, Somnoplasty, which uses radiofrequency energy to reduce the volume of the turbinates. Hopefully you will be able to breathe well through your nose again.

You should discuss your concerns with your surgeon, and possibly get other opinions.

Good luck and be well.

Dr. P

Michael A. Persky, MD

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

March 10th, 2009

Breathing Complications After Rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hi Tiff,

Sorry for your bad experience with your rhinoplasty. Even in the best of hands sometimes unsatisfactory results may occur. Your surgeon has tried his best to get a successful result.

It sounds (no pun intended) like you may now have a perforation (a hole) in your nasal septum which would account for the noise that you are describing. If there is a perforation, it is correctable but would require another surgery.

Your breathing may benefit from reducing the size of your inferior nasal turbinates. There is a non-invasive, non-surgical method, Somnoplasty, which uses radiofrequency energy to reduce the volume of the turbinates. Hopefully you will be able to breathe well through your nose again.

You should discuss your concerns with your surgeon, and possibly get other opinions.

Good luck and be well.

Dr. P

Michael A. Persky, MD

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Sniffling and a runny nose are both related to allergies.

May 22nd, 2009
{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It is good that you had tried the cortisone nasal sprays to try to relieve your nasal congestion. Sometimes this can occur from unrelated issues such as allergies, and the swelling from turbinates, which can be caused from allergies. Cortisone nasal sprays will help with this. Bone and cartilage would need to be removed from the nose if the patient needs a septoplasty for a preexisting deviated septum that was not addressed by primary surgery. Sniffling and a runny nose are both related to allergies.

William Portuese, MD
May 22nd, 2009

Sniffling and a runny nose are both related to allergies.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It is good that you had tried the cortisone nasal sprays to try to relieve your nasal congestion. Sometimes this can occur from unrelated issues such as allergies, and the swelling from turbinates, which can be caused from allergies. Cortisone nasal sprays will help with this. Bone and cartilage would need to be removed from the nose if the patient needs a septoplasty for a preexisting deviated septum that was not addressed by primary surgery. Sniffling and a runny nose are both related to allergies.

William Portuese, MD

May want to seek a second opinion

March 11th, 2009
{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It sounds like you have been through a lot. While you may have a very good surgeon, it sounds like you have had several setbacks and unfortunate outcomes. You may want to consider a second opinion. Every time you operate on the nose, you are causing more scar tissue and destroying tissues that may be needed for a later surgery. Right now, it sounds like you need spreader grafts modified and repair of septal perforation. You may also benefit from partial turbonate resection to help your breathing. To help your breathing in the mean time, you may want to try BreatheRight strips at night. These pull open your internal valve and allow more air to flow. Good luck.

Web reference: http://www.RealPlasticSurgery.com

David Shafer, MD
March 11th, 2009

May want to seek a second opinion

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It sounds like you have been through a lot. While you may have a very good surgeon, it sounds like you have had several setbacks and unfortunate outcomes. You may want to consider a second opinion. Every time you operate on the nose, you are causing more scar tissue and destroying tissues that may be needed for a later surgery. Right now, it sounds like you need spreader grafts modified and repair of septal perforation. You may also benefit from partial turbonate resection to help your breathing. To help your breathing in the mean time, you may want to try BreatheRight strips at night. These pull open your internal valve and allow more air to flow. Good luck.

Learn more: http://www.RealPlasticSurgery.com

David Shafer, MD

Sorry!

March 10th, 2009
{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Well you have been through a long and bad experience. Having benefit of physical exam of your internal nasal structures is key to make recommendations. I can throw out thoughts however, and add to what others have said.

Too much structural cartilage was removed from the tip, thus weakening it. Inspiration (breathing in) created enough negative pressure that the nostrils collapsed, and breathing was compromised.

At this point, a secondary procedure was indicated to add support and structure to the nostrils. It sounds like you suffered a healing complication, where a hole formed in the septum that separates each nostril chamber. When you breath, you may whistle.

A small septal perforation may heal all by itself, but frequently, they require yet another operation. Fortunately, this may be covered by insurance.

My advice to you is this. A nose is not something that you can keep operating on forever. I would recommend a second opinion with a rhinoplasty surgeon wit the best reputation you can find. Fixing septal perforations is tricky, so be sure he feels comfortable with it.

Best of luck to you.

scottkinfw@msn.com
www.drkasden.us

Scott E. Kasden, MD, FACS
March 10th, 2009

Sorry!

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Well you have been through a long and bad experience. Having benefit of physical exam of your internal nasal structures is key to make recommendations. I can throw out thoughts however, and add to what others have said.

Too much structural cartilage was removed from the tip, thus weakening it. Inspiration (breathing in) created enough negative pressure that the nostrils collapsed, and breathing was compromised.

At this point, a secondary procedure was indicated to add support and structure to the nostrils. It sounds like you suffered a healing complication, where a hole formed in the septum that separates each nostril chamber. When you breath, you may whistle.

A small septal perforation may heal all by itself, but frequently, they require yet another operation. Fortunately, this may be covered by insurance.

My advice to you is this. A nose is not something that you can keep operating on forever. I would recommend a second opinion with a rhinoplasty surgeon wit the best reputation you can find. Fixing septal perforations is tricky, so be sure he feels comfortable with it.

Best of luck to you.

scottkinfw@msn.com
www.drkasden.us

Scott E. Kasden, MD, FACS

Too soon to make any judgement after Rhinoplasty

March 10th, 2009
{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The swelling inside your nose may take 6-12 months to slowly resolve. I would be patient and ask your surgeon if you have a perforation. If you have this you may want to have it repaired along with treatment for your breathing problem if it doesn't go away. You should see a revision rhinoplasty expert to evaluate your problem.

Toby Mayer, MD

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

March 10th, 2009

Too soon to make any judgement after Rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The swelling inside your nose may take 6-12 months to slowly resolve. I would be patient and ask your surgeon if you have a perforation. If you have this you may want to have it repaired along with treatment for your breathing problem if it doesn't go away. You should see a revision rhinoplasty expert to evaluate your problem.

Toby Mayer, MD

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Yours is an unfortunate story

March 10th, 2009
{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I am sorry to hear about your troubles. I think at this point you have several problems, possibly also a septal perforation, and need to see a rhinoplasty expert. Dr. Rollin Daniel in Newport Beach CA is close to you and is considered to be an international expert. I would advise that you get your op notes and photos from your doctor and make an appointment to drive up and see him for a thorough evaluation. Hopefully something can be done to make this better!

Richard P. Rand, MD, FACS
March 10th, 2009

Yours is an unfortunate story

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I am sorry to hear about your troubles. I think at this point you have several problems, possibly also a septal perforation, and need to see a rhinoplasty expert. Dr. Rollin Daniel in Newport Beach CA is close to you and is considered to be an international expert. I would advise that you get your op notes and photos from your doctor and make an appointment to drive up and see him for a thorough evaluation. Hopefully something can be done to make this better!

Richard P. Rand, MD, FACS

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.