Rhinoplasty Risks: What’s Expected, What’s Uncommon, What’s Rare

In this guide11 sections

1. Rhinoplasty Risks by How Often They Happen
2. The Risk People Underestimate
3. When to Seek Help After Rhinoplasty
4. How to Reduce Your Risk
5. Risks That Appear Years Later
6. Risks That Are Higher in Certain Situations
7. Risks of Non-Surgical Rhinoplasty
8. What You Should Be Told Before Consenting
9. Rhinoplasty Risks FAQs
10. How We Manage Risk at Centre for Surgery
11. Related Reading

Every operation carries risk, and rhinoplasty is no exception. Serious complications are uncommon in experienced hands, but “uncommon” is not “never”, and you are entitled to know what can go wrong before you consent to anything.

The most useful thing to understand is that rhinoplasty risks fall into three different categories, and people worry about the wrong ones. The dramatic complications — infection, bleeding, loss of smell — are genuinely rare. The commonest source of dissatisfaction is not a complication at all: it is a technically sound operation that produced a result the patient did not expect.

This page sets out the nose job risks that are expected, those that are uncommon, and those that are rare, when to seek help, and what actually reduces your risk.

Rhinoplasty Risks by How Often They Happen

Expected in almost everyone

These are not complications. They are what recovery looks like.

Swelling for months, with the tip last to settle. About 80% resolves by three months and the rest can take a year or longer. See rhinoplasty swelling.

Bruising around the eyes, peaking at days three to four, particularly where the nasal bones have been repositioned.

Numbness of the tip and upper lip, usually improving over three to six months.

A blocked feeling for two to three weeks while the internal lining heals. See blocked nose after rhinoplasty.

Stiffness of the tip, softening gradually over months.

Uncommon

Infection. Uncommon in nasal surgery because the blood supply is excellent. Prophylactic antibiotics are prescribed. Signs are spreading redness, warmth, unusual discharge and fever.

Bleeding needing treatment. Minor ooze in the first 24 hours is normal. Heavy or persistent bleeding is not and needs assessing.

Persistent asymmetry. Every nose is slightly asymmetrical beforehand and remains so afterwards. Asymmetry that is noticeable at twelve months, once swelling has resolved, is a different matter.

Altered breathing. Narrowing the nose can narrow the airway. This is why structure is preserved rather than simply reduced, and why over-resection is the error that causes it. See nasal valve collapse.

Visible irregularities under thin skin. Small edges of cartilage or bone can become palpable or visible where the skin is thin.

Rare but serious

Septal haematoma — blood collecting between the septal cartilage and its lining. It needs draining within days, because the cartilage loses its blood supply and dies, and the bridge then collapses weeks later into a saddle nose deformity. Rare, and the reason increasing pressure or a blocked nostril after surgery is taken seriously.

Septal perforation — a hole through the septum, more associated with septal surgery than cosmetic work. Can cause whistling, crusting and bleeding. See septal perforation.

Loss or alteration of smell. Temporary reduction from swelling is common; permanent loss is rare. The risk is higher where sinus surgery is combined with rhinoplasty.

Skin problems at the incision, including necrosis. Rare, and strongly associated with smoking, which is why we ask patients to stop for four weeks either side.

Anaesthetic complications. Rare in fit patients undergoing day-case surgery. We use TIVA total intravenous anaesthesia with a dedicated consultant anaesthetist throughout. We do not offer twilight sedation for rhinoplasty, because the airway is less well protected during nasal surgery.

The Risk People Underestimate

The commonest reason people are unhappy after rhinoplasty is not a complication. It is a result that was technically correct but not what they had pictured.

Roughly 5 to 15% of primary rhinoplasty patients seek revision surgery, and the majority of those are not because something went wrong — it is because expectation and outcome did not match. Our own revision rate is 5 to 10%, based on eight years of outcomes data, against a UK average of 15 to 20%.

This is why consultation matters more than technique in determining satisfaction. A surgeon who tells you what is not achievable for your skin thickness and cartilage is reducing your risk more effectively than any surgical refinement. See are my rhinoplasty expectations realistic and nose job gone wrong.

When to Seek Help After Rhinoplasty

Contact the clinic the same day if you have:

• Heavy bleeding that does not settle with pressure and sitting upright
• A temperature above 38°C
• Spreading redness or warmth of the skin over the nose
• Pain that is increasing rather than settling, or not controlled by your medication
• One nostril becoming completely blocked, particularly with increasing pressure — this may indicate a septal haematoma
• Skin over the nose turning white, dusky or dark

These are expected and need no action: swelling and bruising, a blocked feeling for weeks, numbness of the tip and lip, fluctuation in swelling from day to day, and a tip that still looks full at six months.

Patients have their surgeon’s direct number for the first 24 hours, and our post-operative team is available from 9am to 6pm, Monday to Saturday. If you are unsure whether something matters, call — that is what the number is for, and we would far rather assess something that turns out to be normal.

How to Reduce Your Risk

Stop smoking four weeks before and four weeks after. The single biggest thing within your control. Nicotine narrows the small vessels supplying healing skin, which drives wound-healing problems, poor scarring and in rare cases necrosis. Vaping and nicotine replacement have the same effect. The NHS Quit Smoking service is free.

Choose a surgeon who performs rhinoplasty regularly. Volume correlates with outcome in rhinoplasty more than almost any other cosmetic operation. See choosing a nose job surgeon in London.

Disclose everything you take. Aspirin, ibuprofen and other NSAIDs stop two weeks before. So do fish oil, vitamin E, ginkgo, garlic supplements and St John’s wort — all of which thin the blood and none of which people think of as medication.

Follow the first two weeks properly. Head elevated, no nose-blowing, no strenuous activity, splint left alone. Most early complications trace back to this fortnight.

Do not judge the result early. Twelve months minimum before considering revision, eighteen in thick skin. Judging at three months means judging swelling.

Report problems immediately. Almost everything on this page is treatable when caught early and considerably harder later. A septal haematoma drained within days is a minor procedure; the same haematoma left for a fortnight is a collapsed bridge.

Risks That Appear Years Later

Some consequences of rhinoplasty do not show for a decade or more, and they are rarely discussed before surgery.

Late collapse from over-resection. A nose reduced too aggressively loses the internal support that holds the airway open. In the first years the soft tissue compensates; as it thins with age, the middle third can pinch and breathing deteriorates. This is the commonest reason people present for functional revision twenty years after a purely cosmetic operation.

The tip drops further. All noses descend with age as the supporting ligaments loosen. A nose whose tip support was weakened at surgery descends sooner and further.

A polly beak can develop late as scar tissue accumulates above the tip. See polly beak deformity.

Skin thins over the framework. Edges that were invisible at thirty can become visible at sixty, particularly where the skin was thin to begin with.

This is the argument for preservation over reduction. Techniques that keep the framework intact and reshape rather than remove tend to age considerably better. See preservation rhinoplasty.

Risks That Are Higher in Certain Situations

Revision surgery carries higher risk throughout — scar tissue makes dissection unpredictable, blood supply is poorer, and cartilage for grafting is often depleted. See revision rhinoplasty.

Thick skin raises the risk of a result that is less defined than hoped, and of prolonged swelling. It does not raise the risk of complications. See rhinoplasty with thick skin.

Thin skin raises the risk of visible irregularities, because there is less soft tissue covering the framework.

Combined procedures lengthen anaesthetic time. Where a septorhinoplasty addresses both function and appearance this is usually worthwhile, but it should be a deliberate decision. See functional rhinoplasty.

Surgery abroad does not raise the surgical risk itself, but it substantially raises the consequences of a complication, because the surgeon is unavailable when problems arise. See nose job in Turkey.

Smoking raises almost every risk on this page.

Risks of Non-Surgical Rhinoplasty

Filler is frequently presented as the low-risk alternative. It carries less risk overall, but the specific risk it does carry is more serious than anything on the surgical list.

Vascular occlusion is the one that matters. Filler injected into or compressing an artery blocks the blood supply to the skin. The nose has a limited, end-artery supply with few alternative routes, which makes it one of the highest-risk areas on the face for this. Untreated, it causes skin necrosis, and in rare cases filler travelling backwards along the vessels toward the eye has caused permanent blindness.

It is rare, and it is a genuine emergency. Warning signs are severe pain out of proportion, blanching or dusky mottling of the skin, and any visual disturbance. It needs treating within hours with hyaluronidase, which is why the practitioner must hold it on site and know how to use it.

Practical implications. Only have nasal filler from a medical practitioner who can manage a vascular event, never from a non-medic, and never at a venue without hyaluronidase available.

Filler also complicates later surgery. Repeated treatments leave scarring in the tissue planes a surgeon needs to dissect, so tell your surgeon about any filler you have had, however long ago. See non-surgical vs surgical rhinoplasty.

What You Should Be Told Before Consenting

Valid consent means understanding what you are agreeing to, and there are specific things you should hear before signing anything.

What is realistically achievable for your anatomy, including what is not.

Which technique is planned and why — open or closed, whether the bones will be repositioned, whether grafts are needed and where cartilage would be taken from.

The specific risks that apply to you rather than a generic list. Thick skin, thin skin, previous surgery, smoking and breathing problems each change the picture.

What revision would involve if you were unhappy, including who pays and after how long.

The recovery timeline honestly stated — a fortnight before you want to be seen, twelve months to the final result.

And a two-week cooling-off period. This is not a formality. If you feel rushed toward a decision, that is itself a warning sign about the provider.

Rhinoplasty Risks FAQs

How We Manage Risk at Centre for Surgery

Pre-operative assessment confirms you are fit for surgery, reviews your medical history and medications, and includes blood tests where indicated.

TIVA anaesthesia with a dedicated consultant anaesthetist present throughout, rather than sedation.

A CQC-regulated facility. Surgery takes place in our own day-surgery theatre at 95–97 Baker Street, Marylebone, not in a consulting room.

Structured follow-up through the first year, with our nursing team staying in contact over the first two weeks, splint removal at one week, and surgeon reviews thereafter.

Direct access to your surgeon for the first 24 hours after surgery, and our team on 020 7993 4849 (9am to 6pm, Monday to Saturday) after that.

And declining surgery where risk outweighs benefit — including where expectations cannot be met, where someone continues to smoke, or where the anatomy will not deliver what is being asked for.

All surgery is performed by GMC-registered surgeons. We are regulated by the Care Quality Commission and rated Good overall. We recommend a two-week cooling-off period before any surgery is booked.

Phone: 020 7993 4849
Email: contact@centreforsurgery.com
Address: 95–97 Baker Street, Marylebone, London W1U 6RN
Contact us to schedule your consultation

Your initial in-person consultation is £100, redeemable against the cost of surgery if you proceed.

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Related Reading

• Rhinoplasty (nose job)
• Is rhinoplasty worth it?
• Nose job gone wrong
• Rhinoplasty swelling
• Rhinoplasty recovery
• Revision rhinoplasty
• Nasal valve collapse
• Septal perforation
• Saddle nose deformity
• Nose job surgeon London
• Functional rhinoplasty
• Twilight sedation