Rhinoplasty has a strong safety record, but like any surgery it carries real risks — including infection, bleeding, anesthesia reactions, prolonged swelling, and in rare cases a hole in the nasal septum — and knowing them ahead of time is what allows you and your surgeon to plan around them. Serious complications are infrequent when the procedure is performed by a board-certified surgeon in an accredited facility, but no surgery is risk-free, and understanding what can happen helps you set realistic expectations for your results and recovery.
How Common Are Rhinoplasty Complications?
According to the American Society of Plastic Surgeons (ASPS), significant complications from rhinoplasty are infrequent, and most patients recover without incident. The Aesthetic Society echoes this, noting that while every surgical procedure carries some degree of risk, serious problems after nose surgery remain uncommon. That said, rhinoplasty is widely considered one of the more technically demanding cosmetic procedures, which is why revision surgery is more common here than with many other procedures — Cleveland Clinic notes that about 15% of rhinoplasty patients need a follow-up procedure to fine-tune their results.
General Surgical Risks You Should Know
Some risks apply to nearly any surgery performed under anesthesia, not just rhinoplasty. Per ASPS and the Aesthetic Society, these include:
- Adverse reaction to anesthesia
- Hematoma or seroma (a collection of blood or fluid under the skin that may need to be drained)
- Infection and bleeding
- Changes in skin sensation, including numbness
- Scarring
- Allergic reactions
- Damage to underlying structures
- Unsatisfactory results that may require additional procedures
Your surgeon and their staff should walk you through each of these in detail before you consent to surgery, and you’ll be asked to sign consent forms confirming you understand them.
Risks Specific to Rhinoplasty
Beyond the general surgical risks, there are complications unique to reshaping the nose. Both ASPS and Cleveland Clinic point to several nose-specific concerns: skin problems or breakdown from bandaging or from grafting material showing through thin skin, nasal blockage caused by internal swelling, injury to the septum, altered sense of smell, and — with the open surgical approach — a small scar at the base of the nose. If you’re weighing which surgical technique might apply to you, our guide to rhinoplasty procedure steps breaks down the difference between open and closed approaches and how each affects incision placement and recovery.
Understanding Nasal Septal Perforation
One of the more serious, if rare, complications is nasal septal perforation — a hole in the cartilage or bone separating the nostrils. Both ASPS and the American Academy of Facial Plastic and Reconstructive Surgery describe this complication as rare, though they caution that additional surgery may be needed to repair it, and in some cases full correction isn’t possible. Cleveland Clinic explains that a septal perforation can result when a surgeon accidentally damages tissue during surgery on the septum, and that other causes include infection, autoimmune conditions, and insufficient postoperative care. Symptoms can include crusting inside the nose, a whistling sound when breathing, nosebleeds, and in more advanced cases, a visible dip in the bridge of the nose known as a saddle nose deformity. Not every perforation causes symptoms or needs treatment right away — some are simply monitored — but it’s a complication worth discussing candidly with your surgeon during consultation.
Revision Surgery: When Results Don’t Match Expectations
An unsatisfactory aesthetic or functional outcome is one of the more common reasons patients return for a second procedure. Because the nose is a small, three-dimensional structure with unpredictable healing patterns — swelling can take up to a year to fully resolve — even a technically well-performed rhinoplasty can settle into a shape that doesn’t quite match what was planned. That’s part of why Cleveland Clinic’s figure of roughly 15% of patients needing a follow-up procedure isn’t unusual for this surgery specifically. If you’re recovering from a recent procedure and wondering whether what you’re seeing is normal swelling or something to flag for your surgeon, our rhinoplasty recovery timeline walks through what to expect week by week.
Warning Signs to Watch for During Recovery
Most rhinoplasty recoveries proceed without complications, but knowing when to call your surgeon matters. Cleveland Clinic advises contacting your provider if you experience difficulty breathing, nausea or vomiting, signs of infection such as fever or yellow discharge, severe pain, or uncontrolled nosebleeds. Ordinary bruising, swelling, tenderness, and nasal congestion are expected in the first weeks and aren’t cause for alarm on their own — it’s the combination of severe or worsening symptoms, especially fever or heavy bleeding, that warrants a same-day call. Keeping your follow-up appointments gives your surgeon a chance to catch anything unusual early, well before it becomes a larger problem.
How to Minimize Your Risk
You can’t eliminate surgical risk entirely, but you can meaningfully reduce it. ASPS points to a few concrete steps:
- Choose a board-certified plastic surgeon with specific rhinoplasty experience
- Have the procedure performed at an accredited surgical facility
- Disclose your full medical history, including medications and supplements
- Follow your surgeon’s pre- and post-operative instructions closely, including activity restrictions
- Ask direct questions about your specific risk factors during your consultation
Our rhinoplasty FAQs page covers many of the other questions patients bring to a first consultation, from anesthesia to what recovery actually feels like.
Frequently Asked Questions
Is rhinoplasty a dangerous surgery?
No — significant complications are infrequent when rhinoplasty is performed by a board-certified surgeon in an accredited facility, though like any surgery it carries some degree of risk, including anesthesia reactions, infection, and bleeding.
What is the most serious complication of rhinoplasty?
Nasal septal perforation, a hole in the septum, is considered one of the more serious complications, though it’s rare; it can sometimes require additional surgery and, in some cases, may not be fully correctable.
How common is it to need a second rhinoplasty?
According to Cleveland Clinic, about 15% of rhinoplasty patients need a follow-up or revision procedure to make small changes after the initial surgery.
Can rhinoplasty affect my sense of smell?
Yes, alteration of sense of smell is a recognized potential complication of rhinoplasty, according to Cleveland Clinic, though it is not among the most common outcomes.
How can I lower my risk of complications?
Choosing a board-certified surgeon with rhinoplasty-specific experience, having the procedure at an accredited facility, and closely following pre- and post-operative instructions are the steps ASPS recommends for minimizing risk.
Discuss Your Risk Profile With Dr. Markarian
Every patient’s anatomy, health history, and goals are different, which means your personal risk profile for rhinoplasty is different too. Dr. Mark K. Markarian, MD, MSPH, FACS, is a Harvard-trained, board-certified plastic surgeon based in Wellesley, MA, whose focus areas include rhinoplasty — including ethnic rhinoplasty — facelifts, and breast and body surgery. A thorough consultation is the best place to ask about the risks that apply specifically to you and how they’re managed. You can book a virtual consultation to get started, or browse our rhinoplasty gallery to see examples of real results.
This article is for general educational purposes only and is not a substitute for personalized medical advice. Individual results and risk factors vary; consult a board-certified plastic surgeon to discuss your specific situation.
