What are the Complications of Rhinoplasty-various aspects-
Rhinoplasty (nose surgery) may lead to a range of complications, including bleeding, infection, scarring, and alterations to the nose’s appearance.
Bleeding
Intense bleeding from the surgical site
Minor blood vessels bursting, which results in red spots on the nose
Blood clots under the skin that impede healing
Infection
Infection that might necessitate antibiotics or further surgery
Adverse reaction to sutures, dressings, or antiseptic solutions
Scarring
Keloids and hypertrophic scars that are elevated and thickened
Scarring at the base of the nose
Changes to the nose’s appearance
The nose might appear uneven
The nose could flatten due to a compromised support structure
The nose might display an inverted-V deformity or asymmetry
Other complications
A perforation in the nasal septum (nasal septal perforation)
Discomfort, discoloration, or swelling that may persist
Altered sensation in the nose or upper front teeth
Reduced sense of smell
Challenges breathing through the nose
Management
Refrain from vigorous activities and adhere to your surgeon’s recommendations regarding bleeding management
Promptly seek medical attention if significant bleeding occurs
A subsequent procedure may be necessary to rectify a minor deformity
Rhinoplasty is considered to have many risks as there may be discrepancies between patient and physician expectations. In addition to postoperative deformities, numerous other risks and complications must also be taken into account.
Reduction rhinoplasty, for example, can lead to breathing issues, which have been reported in 70% of all revision rhinoplasty patients. However, one must acknowledge that scars and decreased mucosal sensation can create a sensation of a “blocked nose. ”
The primary risks associated with autogenous transplants include dislocation and resorption, while alloplastic materials can lead to infections and extrusion. In this context, silicone implants may have a complication rate ranging from 5% to 20%. Fewer complications are noted with alternative materials such as Gore-Tex.
Complications related to skin and soft tissues can manifest as atrophy, fibrosis, numbness, cysts resulting from displaced mucosa, or subcutaneous granulomas due to ointment material. Postoperative swelling mainly hinges on the osteotomy technique used. Percutaneous osteotomies result in less trauma but might produce visible scars.
Infections, though uncommon, can occasionally be life-threatening (toxic shock syndrome). The risk is elevated when sinus surgery and rhinoplasty are performed together. Osteotomies may also lead to injuries in the orbital area. Necrosis of eyelids due to infections and blindness from central artery occlusion are documented risks. Various other hazards have been reported, including rhinoliquorrhea, brain injury, fistulas between the sinus cavernosus and carotid artery, aneurysms, and thrombosis of the cavernous sinus. Discoloration of incisors can occur due to damage to nerves and vessels. Rhinoplasty can also result in legal disputes with dissatisfied patients, a scenario often referred to as a “typical complication of rhinoplasty. ” This situation can be mitigated through appropriate patient selection and consideration of psychological issues.
Postoperative deformities are recognized as significant risks of rhinoplasty, necessitating revision surgery in 5% to 15% of cases. Analyzing postoperative deformities facilitates the identification of specific risks. The most common postoperative deformity is the “pollybeak,” which occurs when a deep naso-frontal angle, a cartilaginous hump, and diminished tip projection are present prior to surgery. The pollybeak is an indication in approximately 50% of all revision rhinoplasties. Other frequent postoperative deformities include a pendulous and broad nasal tip, retractions of the columella base, and irregularities of the nasal dorsum. These deformities often occur in combination and are attributed to a loss of septal support. Thus, ensuring the stability of the caudal septum during septorhinoplasty is crucial for achieving predictable outcomes. Preserving the position of the tip and columella is among the primary considerations for preventing typical postoperative deformities.
The likelihood of complications from rhinoplasty can be diminished with increased experience. A fundamental requirement is continued education and a sincere differentiation between complications and mistakes.
1 Complication or mistake?
Rhinoplasty is viewed as a procedure with significant risks, mainly due to the uncertain nature of the aesthetic outcome. What contributes to this uncertainty? An ideal result right after surgery could look entirely different a year later. Long-term outcome reports regarding rhinoplasty are uncommon. The unpredictability largely stems from the various dynamics involved in the healing process. Numerous types of tissues are affected, including bone, cartilage, mucosa, skin, fat, fascia, muscles, nerves, vessels, perichondrium, and periosteum. The individual responses of these tissues can often be beyond the surgeon’s control. This is particularly applicable to cartilage, which serves as the primary supporting element of the nose.
An unfavorable outcome of rhinoplasty is evidently recognizable (“everyone is an expert”). The patient frequently holds the surgeon responsible for this outcome, while the surgeon tends to refer to it as a complication. In essence, both situations can occur and are not easily distinguishable in many cases. Complications arise from the individual response and the healing process. They are beyond the surgeon’s control. In such instances, the physician must detect the complication in a timely manner and respond appropriately. However, some “complications” could actually result from errors in preoperative assessment or surgical planning, in using an inappropriate technique, or in postoperative care [1]. A thorough analysis is crucial for prevention. The primary focuses of this article are postoperative deformities, their incidence, and potential contributing factors. It does not cover the various techniques for revision surgery but instead addresses the types of deformities and their prevention. The risks and complications associated with rhinoplasty are highlighted, and the nasal septum is only discussed if it is a crucial component of the deformity. In addition to these deformities, other risks and complications are presented in the following chapter.
2. 1 Functional disturbances
Certain deformities, such as twisted noses and tension noses, are linked to breathing issues. In these situations, rhinoplasty is recommended to enhance function. Conversely, rhinoplasty may also decrease the cross-sectional area of the nasal airways. Consequently, 10% of patients who undergo primary rhinoplasty report either lingering or new breathing difficulties. Among patients seeking revision rhinoplasty, 70% cite breathing issues as their primary concern, mainly due to remaining septal deviations or nasal vestibular stenosis. Valve issues are frequently the result of the separation between the upper lateral cartilages and the septum, which can be identified through acoustic rhinometry. Deep osteotomies can constrict the airways at the piriform aperture. Excessive resections of alar cartilage can lead to alar collapse and semicircular scars. However, in most cases, rhinoplasty does not worsen breathing function.
If a patient’s report of a congested nose cannot be clarified through inspection or measurement, a reduction in mucosal sensitivity must be considered. The sensation of warm and cold air during breathing is crucial for recognizing a properly functioning nose. The loss of sensitivity due to surgical scars can create the illusion of a blocked nasal passage. Additional surgical procedures, such as turbinate resections or expanding the nasal vestibule, do not alleviate the problem and may even exacerbate it.
