Nasal surgery: risks

Speaking of the risks and undesirable consequences of aesthetic rhinoplasty, it is necessary to distinguish basically between accompanying symptoms of the operation such as swelling or a feeling of pressure, and the frequency of their occurrence, i.e. always, more or less frequently, as well as actual risks that do not normally occur but may happen in exceptional cases, such as post-operative bleeding or infection.  

Obviously, any intervention on the body that involves incisions and changes to structures is temporarily associated with some undesirable but inevitable side effects. These are almost always temporary and manifest themselves to a greater or lesser extent in all patients. 

Every patient experiences temporary swelling of the face, especially the nose, after a nose job. This can lead to minor bleeding in the form of haematomas, especially around the eyes. These tend to discolor over time and heal after 2-3 weeks without any complications. The swelling of the face will also subside after a similar period of time. 

Swelling of the nose is a different story; it takes one to several years to subside. Skin thickness is the key factor here. The basic rule here is: the thicker the skin, the longer it takes for the nose to decongest. Nose swelling always starts at the nasal root and continues towards the nasal tip, i.e. the nose tip remains swollen for the longest time. Unluckily, most people view themselves in the mirror from the front, which makes the tip of the nose appear a little too wide for quite a long time, whilst the nose already looks quite good in profile, when viewed from the side. 

We will certainly do whatever we can to reduce the swelling as much as possible and accelerate the healing process to the extent feasible. Nevertheless, it is impossible to outsmart nature completely. 

The healing process can only be controlled to a very limited extent.

A further side effect of the surgery is that a feeling of numbness may occur - at least temporarily - in the area of the nose tip and/or the upper lip, sometimes with a slight impairment of movement. Skin nerves can be injured with every skin incision, and unfortunately this cannot be eliminated completely. However, these usually regenerate again after some time. If you feel that your upper lip is a little stiff, then you can quickly eliminate this by practicing (grimacing: take turns to keep your mouth pointed and grin widely).

Obviously, wound pain may occur after surgery, however it is usually very moderate and can be easily controlled by using normal pain medications such as ibuprofen. Most patients report less postoperative pain and rather a feeling of a blocked nose, like in the common cold, as well as pressure in and around the nose.

The mucous membranes react very sensitively to many different stimuli, including manipulation during surgery. Sometimes this results in the nose either running more or becoming drier than usual, even over months following the procedure. However, the situation returns to regular as time passes. It is crucial to remember that surgery does not fundamentally change the way the mucous membranes react. Accordingly, the same applies to allergies, for example, which cannot be eliminated by surgery. The secretion that runs out of the nose may still be a little bloody in the first few weeks after the surgery. This is totally in line with the norm and nothing to worry about.

Individual wound healing depends on many factors and not that much on how successful the surgery was. Although a nose may look excellent directly after the operation, minor, even barely visible, displacements or, especially in the case of thin skin, slight irregularities in the area of the nasal bridge are always possible on account of unfavorable scarring.

The formation of such irregularities resulting from scars can neither be influenced by the surgeon nor by you as the patient. However, if they become more prominent and clearly visible in the course of time, in most cases it can be compensated by a revision surgery, which can only be performed after one year at the earliest due to the time required for healing.

Similarly, a crooked nose may attempt to return to its former position after surgery. This is primarily due to the stronger muscle and tissue pull on one side. It can be counteracted by appropriate exercises and counterpressure.

In contrast to the undesirable side effects of aesthetic nose surgery, there are complications that do not necessarily have to occur and only concern a very small percentage of all patients who undergo rhinoplasty.

Our actions are principally oriented towards counteracting any potential complications of nasal surgery by implementing preventive measures and thus avoiding complications in the first place. Consequently, all the complications listed here occur very rarely, i.e. in less than 1% of our patients.

We will discuss only the potential risks associated with aesthetic rhinoplasty, which nonetheless do occur with a certain frequency.

This includes post-operative bleeding, which is a rare but one of the earliest complications of the surgery. It is harmless in most cases and stops on its own. In the case that the bleeding does not stop on its own, another short anaesthesia may be required involving the insertion of tamponades into the nose to stop the bleeding. The tamponades will be removed after two days at the latest and will not influence the subsequent aesthetic outcome.

The so-called septal haematoma, which is a bruise on the nasal septum, is another early complication of the surgery. Due to an increase in blood pressure or by pressing after the procedure, a small blood vessel may suddenly rupture between the cartilage of the nasal septum and the overlying mucous membrane and bleed into the space between the cartilage and the mucous membrane.

If left untreated, such a septal haematoma may result in a saddle nose since the cartilage is no longer sufficiently supplied with nutrients. In order to avoid the formation of such a haematoma from the start, all patients undergoing surgery on the nasal septum are fitted with the so-called splints, i.e. thin silicone discs, inserted on both sides of the nasal septum at the end of the operation and left there for at least two days. Subsequently, they are removed in our practice. 

We always check the inside of the nose for the presence of such haematoma during this procedure and also when the nose splint is removed after one week. In the very rare cases when this occurs, the haematoma is punctured under local anaesthesia. This procedure will be repeated two or three times in the following days until we are sure that the effusion has been completely removed and will not form again.

In very rare cases, particularly in the early stages of healing, when there are still sore areas, a bacterial infection mainly of the nasal bridge may occur. Preventive measures are already taken here during the surgery to prevent the development of infections, as the nose can never be free of germs due to its connection to the outside of the body. 

The nose is cleaned from the outside and inside with disinfecting substances and all patients are given a broad-spectrum antibiotic administered directly into the blood once during the surgery, so that it is fully effective during the procedure. Should there nevertheless be the slightest indication of redness, pain and swelling in the postoperative course, we immediately apply a broadly effective antibiotic in tablet form, if required after obtaining a swab to determine the germs. If necessary, this is adapted to the result of the germ determination.

In very rare cases, foreign body responses to the suture material that has been used in the procedure may occur over a period of months. In such situations, a small "lump" usually appears under the skin, which sometimes hurts a little, but doesn't lead to inflammation in the majority of cases.  

Since all sutures dissolve naturally over time, though in some cases only after months to years, it is wisest to allow them to rest and not manipulate them. Only when inflammation with an outward connection is involved will germs be able to migrate in such a way that a bacterial inflammation develops and removal of the suture will be required.