Rhinoplasty Risks: What Can Go Wrong With Nose Surgery?
- May 29
- 11 min read
Written by Mr Tim Biggs, Consultant ENT Surgeon and Rhinologist. Mr Biggs is an RCS-certified cosmetic nasal surgeon and performs functional, cosmetic and revision rhinoplasty in Hampshire.
Rhinoplasty, often called a “nose job”, is one of the most technically demanding operations in facial plastic surgery. It can refine the shape of the nose, improve facial balance and, when required, improve nasal breathing. However, like all surgery, rhinoplasty carries risks.
A good rhinoplasty consultation should not simply focus on the expected improvement. It should also include a clear discussion of what can go wrong, what is common during recovery, what is rare but important, and what can be done to reduce risk.
As a consultant ENT surgeon and rhinologist specialising in functional, cosmetic and revision rhinoplasty, I spend a significant part of every consultation discussing risk. This is not to alarm patients, but to make sure expectations are realistic and that patients feel properly informed before making a decision about surgery.
This article explains the main risks of rhinoplasty, including swelling, bruising, bleeding, infection, scarring, breathing problems, asymmetry, dissatisfaction and revision surgery.
Is rhinoplasty safe?
For most patients, rhinoplasty is a safe and well-tolerated procedure when performed by an appropriately trained surgeon in a suitable surgical facility. Serious complications are uncommon.
However, rhinoplasty is also a highly precise operation. Small changes to bone, cartilage and soft tissue can have a visible effect on the appearance of the nose and may also affect nasal airflow. This is why careful planning, realistic expectations and preservation of nasal support are so important.
The aim of surgery is not simply to make the nose smaller. In my practice, the goal is to refine the nose while maintaining or improving nasal function, structural support and long-term stability.
Common temporary side effects after rhinoplasty
Some symptoms are not really “complications” but expected parts of recovery. These usually improve gradually over the first few weeks and months.
Common temporary side effects include:
Swelling of the nose
Bruising around the eyes
Nasal congestion or blockage
Mild blood-stained discharge
Temporary numbness or altered sensation
Stiffness of the nasal tip
Temporary asymmetry due to swelling
Tenderness around the nasal bones
Dryness or crusting inside the nose
Swelling is usually most obvious in the first few weeks. Bruising, if it occurs, often improves within 10–14 days. Nasal tip swelling and stiffness can take much longer to settle, particularly after open rhinoplasty, thick skin rhinoplasty, revision rhinoplasty or complex tip work.
Most patients see a clear improvement within the first few months, but the final result of rhinoplasty can take 12 months or longer to mature.
Swelling and bruising after rhinoplasty
Swelling is expected after rhinoplasty. It is usually most noticeable in the bridge and tip of the nose. The tip often remains swollen for longer because the skin and soft tissue envelope in this area takes time to contract and settle.
Bruising varies significantly between patients. Some people have very little bruising, while others develop visible bruising around the lower eyelids and cheeks. This does not necessarily mean anything has gone wrong.
Techniques such as careful tissue handling, precise bone reshaping and Piezo ultrasonic instrumentation may help reduce trauma in selected cases, but swelling and bruising cannot be eliminated completely.
Patients can help reduce swelling by:
Keeping the head elevated in the early recovery period
Avoiding strenuous exercise until advised
Avoiding knocks or pressure to the nose
Following post-operative cleaning and spray instructions
Attending follow-up appointments as arranged
Bleeding after rhinoplasty
A small amount of bleeding or blood-stained discharge is common in the first few days after rhinoplasty. This usually settles with simple measures.
More significant bleeding is uncommon, but it can occur after any nasal operation. The risk may be slightly higher in patients taking blood-thinning medication, patients with bleeding disorders, or those who restart strenuous activity too soon after surgery.
Patients should avoid aspirin, anti-inflammatory medication and herbal supplements before surgery unless specifically advised otherwise. Any medication that affects bleeding should be discussed before the operation.
In my practice, nasal packing is not routinely used after rhinoplasty. This helps make recovery more comfortable, although each case is assessed individually.
Infection after rhinoplasty
Infection after rhinoplasty is uncommon, but it is a recognised risk. The nose contains bacteria, and surgery involves working through nasal lining and soft tissue.
Signs of infection may include:
Increasing redness
Increasing pain
Swelling that worsens rather than improves
Fever
Feeling systemically unwell
Offensive discharge
Pus-like discharge from the nose or wound
Most minor infections can be treated successfully with antibiotics if recognised early. Serious infection is rare, but patients should contact their surgical team promptly if symptoms are worsening rather than gradually improving.
Breathing problems after rhinoplasty
Rhinoplasty can improve breathing when structural problems are addressed properly. These may include a deviated septum, turbinate enlargement, internal nasal valve narrowing or external nasal valve collapse.
However, breathing can also worsen if too much structural support is removed or if the nasal valve area becomes narrowed. This is one of the reasons why rhinoplasty should not be viewed as a purely cosmetic operation. The nose is both a visible facial feature and an airway.
Potential causes of breathing problems after rhinoplasty include:
Residual or recurrent septal deviation
Internal nasal valve narrowing
External nasal valve weakness
Excessive narrowing of the nasal bridge
Scar tissue inside the nose
Turbinate swelling
Collapse of the side wall of the nose during inspiration
As an ENT surgeon and rhinologist, I assess both the cosmetic and functional aspects of the nose. This includes looking at the septum, turbinates, nasal valves and the relationship between nasal shape and airflow.
The best cosmetic rhinoplasty result is not a nose that looks good but does not work. The aim should be a nose that looks natural, suits the face and maintains good breathing.
Asymmetry after rhinoplasty
No human face is perfectly symmetrical, and no nose is perfectly symmetrical. Rhinoplasty can improve asymmetry, but it cannot guarantee absolute symmetry.
Asymmetry may relate to:
Previous trauma
A deviated septum
Unequal nasal bones
Unequal nostrils
Tip cartilage asymmetry
Facial asymmetry
Uneven swelling during recovery
It is particularly important for patients to understand that some asymmetry is normal during healing. One side may swell more than the other, especially in the early months.
The aim of surgery is meaningful improvement, not mathematical perfection.
Scarring after rhinoplasty
Closed rhinoplasty uses incisions inside the nose, so there is no external skin scar.
Open rhinoplasty uses a small incision across the columella, which is the narrow strip of skin between the nostrils. This gives excellent access to the nasal tip and framework, which can be important in structural, complex or revision surgery.
The columellar scar usually heals very well and often becomes difficult to see with time. However, all scars are permanent, and scar quality can vary between patients.
Poor scarring is uncommon, but risks include:
Thickened scar
Redness
Pigmentation change
Visible scar line
Delayed wound healing
Good surgical technique, careful wound closure and appropriate aftercare help reduce the risk of visible scarring.
Skin problems after rhinoplasty
Skin-related complications are rare but important. The skin over the nose relies on a healthy blood supply. Excessive pressure, infection, smoking, previous surgery, trauma or filler treatment may increase risk.
Rare skin complications include:
Delayed healing
Skin blistering
Skin colour change
Skin thinning
Skin necrosis
Skin compromise is unusual after standard rhinoplasty, but it is more relevant in complex revision cases, patients with previous nasal surgery, patients with significant scarring, or those who have had previous nasal filler.
Patients should always tell their surgeon if they have had previous non-surgical rhinoplasty or filler injections to the nose.
Numbness and altered sensation
Temporary numbness around the nasal tip, upper lip or front teeth can occur after rhinoplasty. This is usually due to swelling and temporary irritation of small sensory nerves.
For most patients, sensation gradually returns. Occasionally, altered sensation can persist for longer. Permanent numbness is uncommon but possible.
Patients may also notice stiffness or reduced movement of the nasal tip in the early recovery period. This usually improves as swelling settles and the soft tissues relax.
Septal perforation
A septal perforation is a hole in the nasal septum, the wall that divides the two sides of the nose. It is an uncommon but recognised risk of septal surgery and septorhinoplasty.
Small perforations may cause no symptoms. Larger or symptomatic perforations can cause:
Crusting
Whistling
Bleeding
Dryness
Nasal blockage
Recurrent irritation
The risk is higher in revision surgery, previous septal surgery, trauma, infection, inflammatory disease and cocaine use.
Careful handling of the septal lining reduces the risk, but it cannot be removed completely.
Changes to smell
Temporary changes in smell can occur after rhinoplasty or septorhinoplasty, usually because of swelling, crusting and nasal congestion. This normally improves as the nose heals.
Persistent smell disturbance is uncommon, but any patient with prolonged loss of smell should be assessed.
Cosmetic dissatisfaction after rhinoplasty
One of the most important risks of rhinoplasty is not a medical complication, but dissatisfaction with the cosmetic result.
This may happen because:
The nose has not changed enough
The nose has changed too much
The tip remains swollen
The bridge is not as smooth as expected
There is residual asymmetry
The patient’s expectations were not achievable
Healing has changed the intended result
Scar tissue has affected the final shape
Rhinoplasty requires judgement as well as technical skill. The aim is not to create a generic or artificial-looking nose, but to produce a natural result that suits the individual face.
Pre-operative discussion is therefore essential. I use photography and, where appropriate, 3D simulation to help patients understand what may be achievable. Simulation is a communication tool, not a guarantee of the final outcome.
Revision rhinoplasty
Revision rhinoplasty means further surgery after a previous rhinoplasty. This may be needed for functional reasons, cosmetic reasons, or both.
Published revision rates vary, but many studies quote revision rhinoplasty rates in the region of 5–15%, depending on complexity, surgical technique, patient factors and how revision is defined.
In my own practice, my revision rate over the last 200 rhinoplasty cases is approximately 4%. This is lower than many quoted figures in the literature, but it is still important to be clear that no surgeon can offer a zero revision rate.
Revision may be considered for:
Persistent nasal obstruction
Residual hump or irregularity
Tip asymmetry
Pollybeak deformity
Over-resection
Under-correction
Nostril asymmetry
Collapse of the nasal side wall
Graft visibility or movement
Patient dissatisfaction despite uncomplicated healing
Revision surgery is usually more complex than primary rhinoplasty because normal tissue planes have been altered and cartilage support may have been weakened or removed.
Some revision cases require additional graft material, such as donor rib cartilage or fascia, to rebuild nasal support.
Risks of revision rhinoplasty
Revision rhinoplasty has a higher level of complexity than primary surgery.
The risks include:
More swelling
Longer healing time
Less predictable scar tissue
Limited septal cartilage for grafting
Need for donor cartilage or fascia
Higher risk of irregularity
Higher risk of breathing problems
Higher chance of needing further revision
This does not mean revision rhinoplasty cannot be successful. Many patients can achieve significant improvement. However, it requires careful planning, realistic goals and a surgeon experienced in both nasal function and nasal reconstruction.
Rare but serious risks of rhinoplasty
Serious complications after rhinoplasty are rare, but they should still be discussed during consent.
Rare risks include:
Significant bleeding requiring treatment
Severe infection
Skin compromise
Septal haematoma
Septal perforation
Adverse reaction to anaesthetic
Deep vein thrombosis or pulmonary embolism
Visual symptoms
Cerebrospinal fluid leak in extremely unusual circumstances
Visual symptoms, severe headache, eye pain or sudden swelling around the eye after nasal surgery should be treated as urgent.
The vast majority of patients do not experience serious complications, but proper consent means understanding both common and rare risks.
How I reduce risk in my rhinoplasty practice
Risk can never be removed completely, but it can be reduced through careful assessment, planning, surgical technique and aftercare.
In my practice, risk reduction includes:
Detailed pre-operative consultation
Assessment of both appearance and breathing
Internal nasal examination
Discussion of realistic goals
Pre-operative photography
3D simulation where useful
Careful consent process
Preservation of nasal support
Structural grafting where required
Attention to the nasal valves
Conservative and precise bone reshaping
Piezo ultrasonic instrumentation where appropriate
Avoidance of routine nasal packing
Clear post-operative instructions
Planned follow-up during recovery
The key principle is that cosmetic refinement should not come at the expense of nasal function.
When should I contact my surgeon after rhinoplasty?
Most symptoms after rhinoplasty are expected and settle gradually. Swelling, bruising, congestion, mild blood-stained discharge and temporary numbness are common in the early recovery period.
However, you should contact your surgical team promptly if you experience:
Persistent or heavy bleeding that does not settle
Increasing pain rather than gradual improvement
Fever or feeling systemically unwell
Increasing redness, heat or swelling around the nose
Discharge that becomes offensive or pus-like
A change in skin colour over the nose
Sudden worsening of breathing
Visual symptoms, severe headache or eye pain
Serious complications after rhinoplasty are rare, but early assessment is important if symptoms are unexpected or worsening. Patients should always be given clear post-operative contact details before surgery so they know who to contact if they are concerned.
Is rhinoplasty worth the risk?
For the right patient, rhinoplasty can be a very positive operation. It can improve nasal shape, facial balance, confidence and, in functional cases, breathing.
However, it is not an operation to rush into. Patients should understand the limitations as well as the benefits. The best candidates are those who have clear concerns, realistic expectations and a good understanding of the recovery process.
A successful rhinoplasty is not simply about changing the nose. It is about achieving a natural, balanced and stable result that works with the rest of the face.
Key take-home message
Rhinoplasty is generally safe when performed by an experienced surgeon, but it is not risk-free. Common temporary effects include swelling, bruising, congestion and numbness. Less common risks include bleeding, infection, scarring, breathing problems, asymmetry, dissatisfaction and the need for revision surgery.
The most important way to reduce risk is careful patient selection, detailed planning, preservation of nasal support and honest communication between surgeon and patient.
If you are considering cosmetic rhinoplasty, septorhinoplasty or revision rhinoplasty, your consultation should include a detailed discussion of your goals, your nasal function, your anatomy, your expected recovery and the specific risks relevant to your case.
About Mr Tim Biggs
Mr Tim Biggs is a Consultant ENT Surgeon, Rhinologist and RCS-certified cosmetic nasal surgeon. He specialises in functional, cosmetic and revision rhinoplasty, including structural rhinoplasty, nasal valve surgery, Piezo rhinoplasty and dorsal preservation techniques.
He sees patients from Fareham, Winchester, Southampton, Portsmouth, Chichester, Basingstoke and across Hampshire.
Last reviewed: June 2026
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Frequently Asked Questions
What is the most common risk after rhinoplasty?
The most common issues after rhinoplasty are temporary swelling, bruising, congestion and numbness. These usually improve gradually. Tip swelling can take many months to fully settle.
Can rhinoplasty make breathing worse?
Yes, it can, although this is uncommon when the nasal framework is properly supported. Breathing can worsen if the nasal valve area becomes narrowed or if too much cartilage support is removed. This is why functional assessment is important before cosmetic rhinoplasty and choosing a surgeon who prioritises breathing conservation in surgery.
How common is revision rhinoplasty?
Published revision rates vary, but many studies quote rates around 5–15%. Revision rates depend on case complexity, surgical technique, healing and patient expectations. In my own practice, my revision rate over the last 200 rhinoplasty cases is approximately 4%.
Can rhinoplasty improve breathing?
Yes. Rhinoplasty can improve breathing when functional problems such as a deviated septum, turbinate enlargement or nasal valve collapse are corrected at the same time. This is often called functional rhinoplasty or septorhinoplasty.
Is infection common after rhinoplasty?
No. Infection after rhinoplasty is uncommon, but it can occur. Increasing redness, worsening pain, fever or offensive discharge should be reported promptly.
Will I have a scar after rhinoplasty?
Closed rhinoplasty has no external skin scar. Open rhinoplasty uses a small incision across the columella between the nostrils. This usually heals very well and often becomes difficult to see with time.
How long does rhinoplasty swelling last?
Most visible swelling improves significantly in the first few weeks, but subtle swelling, especially in the nasal tip, can last 12 months or longer. Thick skin, revision surgery and complex tip work can prolong swelling.
What are the risks of revision rhinoplasty?
Revision rhinoplasty is more complex than primary surgery. Risks include more swelling, less predictable healing, scar tissue, limited cartilage for grafting, breathing problems, irregularity and the possibility of further revision.
Is Piezo rhinoplasty safer?
Piezo ultrasonic instruments allow precise bone reshaping and may reduce trauma to surrounding soft tissues in selected cases. However, no instrument removes risk completely. The overall result still depends on planning, technique, healing and patient factors.
How can I reduce my risk before rhinoplasty?
Choose an appropriately trained surgeon, be honest about your medical history, avoid smoking, follow medication advice, avoid trauma after surgery and attend follow-up appointments. It is also important to have realistic expectations and to understand that final results take time.
