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Risks and
possible complications

Making an informed decision about your surgery.

A number of risks and complications have been noted over the years in association with rhinoplasty surgery.

Although the list here is not comprehensive, we have tried to present some of the most relevant or more common complications recorded.

It is important for you to discuss them at the time of your consultation, so that you can make an informed decision about your surgery.

Anaesthetic

Although the anaesthesia has reached extremely high levels of safety even compared to things we do on a daily basis, the risks are not zero. It is estimated that for a healthy adult, the risks related to an anesthetic are somewhere in the area of 1:100000.

It is interesting to note that the risks are related to local anaesthetic with sedation are actually higher than the ones from a general anaesthetic. For the purpose of comparison, the risks of driving on a motor way are about 4 times higher than having a general anaesthetic.

Bleeding

During rhinoplasty surgery, a small amount of bleeding is normal. After the surgery is finished, there he is usually also a small amount of blood oozing from the nose, which tends to settle down within the first 24 hours. For this reason, when you wake up from surgery, he can expect to see a small dressing under your nose.

More significant bleeding, in the form of a typical nosebleed, is much less frequent, and the rate is at approximately 1:100. In most instances, it will settle down with gentle pressure on the nostrils, but on occasion may require some medication or even using a nose pack to control it.

It is important that if you do have a nosebleed following your surgery, you should contact us straight away for guidance.

Infection

Infection is rare following rhinoplasty surgery, but can occur despite the antibiotic treatment prescribed.

Most of the time, it takes the form of some redness around the scars on the columella or nostril base, the which tends to settle either with topical antibiotics or Savlon cream.

However, if you noticed the redness and swelling occurring around the nose or the cheeks, temperature, increasing pain, shivering, it is important to either contact us straight away, or discuss it with your GP or your local casualty department, for assessment and antibiotic treatment.

Get in touch. Talk to our helpful team or book a consultation with Mr Lucian Ion. Call 0207 486 7757

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Deep vein thrombosis

Any surgery that takes longer than an hour increases the risk of clots in the leg veins or deep vein thrombosis, similar to what can happen when you fly on a long journey. In some instances, these clots can travel to the lungs and become life threatening .

Typically, medication that thins the blood, increases significantly the risk of nosebleeds, and is avoided during rhinoplasty surgery.

Alternative measures to reduce the risk of deep vein thrombosis around the time of surgery include compression stockings, inflatable calf or boots systems that are applied during and after the surgery, early mobilisation within hours of surgery, and maintaining a good fluid intake in the days following your operation.

Please note that contraceptive medication and to a lesser extent hormone replacement therapy increase somewhat the risk of deep vein thrombosis.

It is estimated that it takes 3 months off the medication to bring the risk levels down to baseline, and because of the risk of unwanted pregnancies, most of the time the surgery is carried out without stopping contraception.

Pain and discomfort

Rhinoplasty is associated with relatively little pain and discomfort, which is typically well controlled with simple pain medication.

Some patients do report headaches or sinus type congestion, after the surgery, which is most likely related to the use of internal silicone splints which block the sinuses.

This is also typically well-controlled by simple pain medication in the form of tablets.

Longer-term pain from rhinoplasty as well as other forms of surgery can occur if the healing of the nerves around the area that was operated on failed to settle normally.

In a situation like this, it is typically the pain management specialists that can be of assistance, as the pain would not typically be relieved by further surgery.

Nasal airway

Breathing through the nose is often improved through the rhinoplasty or septo-rhinoplasty procedures. However, in the first month or two after surgery, it is common to feel that the airway is tighter, as it would be during a cold.

This can be improved with decongestants and the use off saltwater nasal flush, which we typically recommend up the surgery. The most common system we have recommended is Sinurinse®, but there are a lot of other options available on the market.

More persistent or significant nasal airway restriction can occur following the surgery, in part in relation to the nasal septum, and in part due to the narrowing on the lateral walls, as well as to more persistent swelling.

If this occurs, you should bring it to our attention, as he can often be relieved using silicone nasal stents worn at nighttime.

Severe airway obstruction following rhinoplasty is extremely rare, but can pose more significant problems and require revision surgery.

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Septal perforation

The nasal septum is the partition wall that separates the nostrils and nasal airway behind him. In rhinoplasty surgery, and more so in the septal-rhinoplasty which also deals with airway problems, it is possible for a perforation of the septum to become established.

The problem is much more likely to occur in smokers or people the use cocaine, but can happen in anybody.

As a general rule, it is important to avoid blowing the nose for the first 3 weeks after surgery, to reduce tension applied to the septum, and most certainly to avoid picking the nose.

If a septal perforation does occur, in the majority of patients it is inconsequential. In some, it may lead to a whistling noise during breathing or speaking, and required tension because of this.

Larger septal perforations can also be associated with crusting and bleeding, and therefore be a source of more significant discomfort.

There are fortunately very rare, but may also require surgical intervention to improve.

Changes in sensation

With open tip rhinoplasty and to some extent with closed rhinoplasty, it is actually expected that the feeling in the tip of the nose will be decreased, at least for a few months.

Most of the time the recovery of the feeling is very good, but some people report long lasting reduced sensation on some parts of the tip or supra-tip areas.

Stiffness

Very common after open tip rhinoplasty is a degree of stiffness in the tip of the nose, which will take approximately 6 months to settle.

In particular, in the ethnic rhinoplasty, which is typically involving the rib cartilage grafting to the tip and bridge of the nose, it is expected that the tip of the nose will be somewhat firmer indefinitely.

Revision

The need for repeat surgery and rhinoplasty is well understood, and can be related to minor touchups or more significant changes required. It is estimated that approximately 10% of patients undergoing rhinoplasty will have revision procedures.

Swelling

Swelling is inevitable after any type of surgery, but may take different length of time to settle depending on the area is operated upon.

In the rhinoplasty procedures, swelling is mainly located at the junction between the side walls of the nose and cheek, and around the tip of the nose, and will take 1 to 2 years to settle fully.

Nonetheless, the main part of the swelling does settle within approximately a month after surgery, making the shape of the nose relatively normal, even if it does not represent the end result.

Rubbing the nose is not usually a good approach to reducing the swelling, because it irritates the tissues and may make things worse.

Often, simple pressure applied and maintained for a few minutes, several times a day, is the best relief for swelling around the nose.