Rhinoplasty Complications

Rhinoplasty is a safe operation in experienced hands, and serious complications are uncommon. This page is written to be honest about the ones that matter, the genuine adverse events that can happen when healing does not go to plan, rather than the normal swelling and bruising that every patient expects.

Understanding the real complications, how often they occur, how they are recognised and how they are put right helps you make a clear decision and choose your surgeon carefully. Where we give numbers, we give a range drawn from the published surgical literature rather than a single figure, because on a subject like this you deserve honesty, not false reassurance.

Key Takeaways

• Serious complications are uncommon. Most reported problems are minor, and major complications that need intervention are rare in experienced hands.
• Complications are not the same as side effects. Swelling, bruising and numbness are normal healing, covered on our side effects page.
• The complications that matter are septal perforation, infection, haematoma and significant bleeding, poor wound healing, persistent breathing difficulty, healing asymmetry and, rarely, structural collapse.
• Revision is not the same as botched. A published review puts revision rates at roughly 5 to 15 percent, most often to correct the shape, and often breathing as well (sources below).
• Choosing an experienced surgeon and honest planning are the biggest factors in keeping your risk low.

How Common Are Rhinoplasty Complications?

The honest answer is that the risk is low but not zero, and the published figures vary widely depending on how a complication is defined and which patients are studied. It helps to think in three tiers: effects almost everyone gets, which are normal side effects rather than complications; uncommon complications; and rare but serious ones. This page covers the second and third tiers.

• Overall complication rate: published figures vary widely depending on how a complication is defined, and many reported events are minor, such as prolonged swelling or small asymmetries. One published series of 369 cosmetic rhinoplasties reported an overall complication rate of about 8 percent (Neaman and colleagues, Aesthetic Surgery Journal, 2013).
• Major or significant complications that need active treatment, such as serious bleeding, serious infection or an airway problem, are uncommon, commonly reported in the low single digits.
• Revision surgery: a published review reports revision in 5 to 15 percent of cases, most often to correct the shape, and often breathing as well (Rettinger, Risks and complications in rhinoplasty, 2008).

We deliberately give ranges rather than a single headline figure, because a false-precision number would not be honest. The most useful thing to know is that the serious events below are rare, and that most are recognised and managed well when you are under the care of an experienced surgeon.

The Serious Complications Of Rhinoplasty

These are the genuine adverse events, distinct from normal recovery. Each is uncommon, and each is manageable when caught early. They fall into two groups: the general risks of any operation, and the risks specific to the nose.

General surgical risks

As with any procedure under anaesthetic, there is a small risk of a reaction to the anaesthetic and, rarely, of blood clots in the legs or lungs. These are uncommon in fit, well-screened patients, and your team takes active steps to prevent them. The nose-specific complications below are the ones most patients want to understand.

Septal perforation

A hole through the septum, the wall of cartilage and bone that divides the nostrils. It is an uncommon complication of rhinoplasty. It can cause a whistling sound on breathing, crusting, dryness and recurrent bleeding, though many small perforations cause no symptoms at all. It is managed with humidification and lubrication, a small silicone septal button, or surgical repair using cartilage or fascia.

Infection

Reported in less than 1 percent of rhinoplasties in a published review (Rettinger, 2008), and a little more likely in revision surgery or where grafts or implants are used. It can appear within days as redness and swelling, or later as a graft-related problem. It is treated with antibiotics, drainage of any abscess, and, in severe cases, removal of an infected graft or implant.

Haematoma and significant bleeding

Some oozing is normal, but a septal haematoma, a collection of blood under the lining of the septum, is the one to know about. Left untreated it can damage the cartilage and lead to collapse, so it is drained urgently. It usually shows as increasing pressure, blockage or pain in the days after surgery. See the dedicated bleeding section below for what is normal and when to worry.

Poor wound healing and skin problems

Skin breakdown over the bridge of the nose is very rare. The risk is higher in smokers, in people with very thin skin, with over-tight taping, and notably after recent nasal fillers, which is a published and avoidable risk. It is managed with careful wound care and, rarely, later reconstruction. Less seriously, some patients notice persistent redness or small visible surface vessels over the bridge, which usually fades and can be treated if it lingers.

Persistent breathing difficulty

Most people breathe as well or better after surgery, but if supporting cartilage is over-reduced or weakened, the nasal valve can collapse and make breathing harder. This is one of the more common reasons a patient seeks revision. It is corrected with structural grafts, such as spreader or alar batten grafts, that rebuild support.

Lasting change in smell

Most people notice a temporary dulling of smell from early swelling, which settles and is covered as a normal effect on our side effects page. A lasting change to the sense of smell is a recognised but rare complication, more likely where extensive internal work was needed.

Healing asymmetry and contour deformity

A nose heals as living tissue, so small irregularities can appear, including a pollybeak (fullness above the tip), an inverted-V, or slight asymmetry. Much early asymmetry is simply swelling and keeps improving, which is why a settled result should not be judged before around twelve months. Skin type matters here: thicker skin tends to stay swollen longer and can mask fine detail, while very thin skin can show small irregularities more readily. A genuine, fixed structural asymmetry that remains after twelve months may be addressed with revision.

Structural collapse (saddle-nose)

Loss of height and support across the bridge, giving a scooped or saddle shape. It is rare with modern structure-preserving technique, and more likely after infection, an untreated septal haematoma, or over-aggressive removal of septal cartilage. It is corrected with structural cartilage grafting.

Bleeding After Rhinoplasty: What Is Normal And When To Worry

Some bleeding after a nose operation is completely normal, and knowing the difference between normal oozing and a warning sign is one of the most common worries patients have.

• Normal: light bleeding or oozing in the first 24 to 72 hours, and occasional spotting for up to one to two weeks as the lining heals.
• Contact your surgeon if you are soaking through gauze every ten minutes or so, if a nosebleed lasts more than about 30 minutes, or if heavy bleeding starts or continues beyond the first few weeks.

This is bleeding in the context of rhinoplasty recovery. It is not the same as a spontaneous nosebleed in day-to-day life, which is a first-aid matter, not a surgical one.

Can Rhinoplasty Go Wrong? Botched Results And Revision

Yes, like any operation, rhinoplasty can have a disappointing outcome. It is worth being honest about the commonest one: more often than any complication, unhappiness comes from a technically sound result that simply did not match what the patient pictured. That is why careful imaging and an unhurried consultation matter so much, and it is a very different situation from a genuine complication.

"Botched rhinoplasty" is a lay term, not a clinical diagnosis, and it usually describes a poor aesthetic or functional result: an over-reduced or pinched nose, a pollybeak, an obvious asymmetry, or difficulty breathing.

It is important to be honest about what this means. A revision rate of roughly 5 to 15 percent does not mean that 5 to 15 percent of noses are botched. Some revisions are smaller refinements once the tissues have fully settled. A genuine structural or functional problem that persists beyond around twelve months is when revision is properly considered.

Signs of a bad (botched) nose job

If you think your rhinoplasty has gone wrong, a bad result usually means a nose that is clearly out of balance or works worse than before, rather than the normal swelling of early healing. The signs that matter are below, and each is judged once the nose has had time to settle, usually around twelve months:

• A pinched or collapsed tip, or a scooped saddle bridge, from lost support: see nose collapse after rhinoplasty.
• A rounded fullness above the tip, known as a pollybeak: see pollybeak deformity.
• Uneven nostrils or a crooked result: see uneven nostrils after rhinoplasty.
• Breathing that is worse than before surgery: see how rhinoplasty can affect your breathing.
• Persistent lumps or hardness: see scar tissue after rhinoplasty.

Is it a bad result, or still swelling?

Usually, in the early months, it is swelling. The nose takes around twelve months to settle, and the tip settles last, so most early worries about shape are swelling rather than a fault.

• More likely swelling: it is soft or puffy, changes through the day, keeps improving from month to month, and is most noticeable at the tip.
• More likely a real problem: it is firm, fixed or structural, has not changed by around twelve months, or your breathing stays worse than before surgery.

Our swelling timeline shows what to expect at each stage, and if you are unsure, a review with your surgeon is the best way to tell.

How a bad nose job is fixed

A genuine problem is corrected with revision rhinoplasty, usually at least twelve months after the first operation once the tissues have settled, and sometimes using cartilage grafts to rebuild support. The table below summarises the common problems; our dedicated guides cover each in detail.

Revision rhinoplasty with Mr Shoaib, fixed fee £9,950

How To Reduce Your Risk Of Complications

• Choose an experienced, GMC-registered plastic surgeon who performs rhinoplasty regularly. This is the single biggest factor in a safe result. Our checklist for choosing a rhinoplasty surgeon shows what to check.
• Be honest at your consultation about your health, medication, smoking and your expectations, so the plan is realistic and safe.
• Avoid nasal fillers close to surgery, which can compromise the blood supply to the skin.
• Follow your aftercare closely, protect your nose from knocks, and keep every follow-up appointment so any problem is caught early. Our rhinoplasty healing stages guide sets out what to expect.

When To Contact Your Surgeon

Expected swelling and mild discomfort are normal. Contact your surgeon the same day if you notice any of the following, which can be early signs of a complication:

• A temperature above 38°C, or spreading redness, warmth or discharge that suggests infection.
• Increasing pressure or pain on one side, or one nostril becoming completely blocked, which can signal a septal haematoma.
• Skin over the bridge or tip turning white, dusky or dark.
• Heavy bleeding that does not settle with gentle pressure, or a nosebleed lasting more than about 30 minutes.
• Sudden or worsening difficulty breathing, or any change in vision.

Some of these need emergency care, not a phone call. Call 999 or go to your nearest A&E immediately if you have sudden or severe difficulty breathing, chest pain, a sudden change in vision, or bleeding you cannot control. For the other signs above, contact your surgeon the same day.

You should never feel you are bothering us by asking.

Why Read This From A Rhinoplasty Surgeon

This page is reviewed by Mr Taimur Shoaib, a Consultant Plastic Surgeon on the GMC Specialist Register (GMC 3615443) who performs rhinoplasty and revision rhinoplasty at Berkeley Square Medical, 64 Harley Street. He has published peer-reviewed work directly relevant to complications and their avoidance, including an audited single-surgeon series of closed rhinoplasties (Indian Journal of Otolaryngology and Head & Neck Surgery, 2022) and a technique paper on tip control in closed rhinoplasty (European Journal of Plastic Surgery, 2026). As with all single-surgeon research, this is lower-tier evidence, results vary between patients, and no honest surgeon can promise a specific outcome. What we can promise is a candid conversation about your individual risks before you decide anything.