Revision Rhinoplasty

1. Nausea. Postoperative nausea may occur and is treated when needed.
2. Nasal lining irritation and wounds. Irritation or wounds may develop inside the nose, requiring additional care or medication.
3. Postoperative obstruction. Early blockage may result from swelling and crusting. Its course is assessed during follow-up.
4. Bleeding and haematoma. Bleeding during or after surgery may require packing, evacuation of collected blood, another operation or transfusion.
5. Discomfort from packing or splints. Internal materials may cause sneezing, pressure and a blocked sensation.
6. Infection. Infection may develop in the nose or around materials, requiring medicines, material removal or further intervention.
7. Persistent or worsening breathing problems. Existing breathing problems may not fully resolve, or a new problem may develop. Medication and additional surgery may be needed.
8. Unmet appearance expectations. Final appearance is difficult to assess before healing is complete. Remaining irregularities may require another intervention.
9. Persistent or recurrent deviation. Bone and cartilage deviation may not be fully corrected and may recur during or after healing.
10. Tear duct injury. Injury or effects on the tear duct may impair drainage and require further assessment or surgery.
11. Skull-base injury and cerebrospinal fluid leakage. Injury to skull-base bone or membranes may cause nasal cerebrospinal fluid leakage and serious problems such as meningitis. Further treatment or surgery may be necessary.
12. Unintended fractures near the jaw or eyes. Unplanned fracture lines may develop during bone work. Effects on nearby structures or eye muscles may require further surgery.
13. Rib cartilage harvest problems. Rib harvest may injure the pleura and allow air into the chest cavity. A chest drain and further intervention may be required.
14. Hair loss at a donor site. Harvesting supporting tissue such as scalp fascia may cause temporary or permanent hair loss around the incision.
15. Device-related burns. Ultrasonic bone instruments or other surgical devices may cause thermal tissue injury or burns.
16. Septal perforation. A hole may form in the nasal septum. Additional repair surgery may be needed and may not close it completely.
17. Changes in smell. Swelling, airflow changes, infection or injury around the olfactory area may reduce or eliminate smell. Recovery varies and lasting problems are possible.
18. Visual impairment and loss of vision. Eye/nearby tissue injury or vascular problems may affect vision. Permanent vision loss is a reported serious risk.
19. Numbness and altered sensation. Effects on skin nerves may cause temporary or permanent numbness or altered sensation.
20. Prolonged or chronic pain. Pain may persist beyond expected healing. Medication or further interventions may be considered.
21. Prolonged or persistent swelling. Resolution varies between patients. Marked or prolonged swelling may require additional treatment.
22. Allergic reactions. Tape, sutures, topical products or medicines may cause local or systemic allergy.
23. Rhinitis and nasal discharge. Inflammation of the nasal lining may cause discharge, irritation or obstruction. Allergic or vasomotor problems may need separate treatment; rhinoplasty does not eliminate all such conditions.
24. Altered perception of breathing. A feeling of inadequate breathing may occur despite airflow through the nose. Assessment and treatment require a separate plan.
25. Delayed healing and tissue loss. Bone or soft tissue may heal slowly. Skin or other tissue loss may require dressings, tissue removal or further surgery.
26. Wound separation. Trauma, tension or healing problems may separate an incision, requiring dressings or resuturing.
27. Changes in appearance over time. Ageing, sun exposure and tissue changes may affect appearance; not every such change is a surgical complication.
28. Dissatisfaction and further revision. Appearance, palpable irregularities or function may not meet expectations. Further revision may be needed and does not guarantee a flawless result.
29. Scars and colour changes. Internal and external incisions leave scars. Some may be wide, raised or noticeable; skin darkening or lightening may require treatment.
30. Asymmetry. Differences may remain between sides of the nose or face, or new asymmetry may develop. Additional surgery may not eliminate them completely.

1. Breathing and lung problems. Aspiration, respiratory depression, areas of lung collapse, infection or air in the chest cavity may occur. Breathing support, longer admission and further treatment may be necessary.
2. Airway and intubation problems. Placing a breathing tube may be difficult or impossible, requiring postponement. Lips, tongue, teeth, throat or airway injury and a postoperative sore throat may occur.
3. Intravenous line and catheter problems. Lines or catheters can cause bleeding, vessel injury, compromised blood supply or other site-related injuries. Serious tissue damage may need additional treatment.
4. Clots and cardiovascular problems. Leg vein thrombosis, pulmonary embolism, heart attack, stroke or serious circulatory problems may cause permanent damage or life-threatening illness.
5. Reactions to anaesthetic drugs. Medicines may cause allergy or anaphylaxis, blood pressure/pulse changes, arrhythmias or cardiac/respiratory arrest. Malignant hyperthermia is another serious reaction. Severe anaesthetic complications can be fatal.
6. Position and pressure-related problems. Prolonged positioning may cause nerve compression, numbness, weakness, restricted movement, pressure sores or eye/other tissue injuries. Surgical devices may also cause burns.
7. Recovery from anaesthesia. Drowsiness, confusion or nausea may occur. Smoking, obesity and medical conditions may increase some cardiac, respiratory and clotting risks.
8. When local anaesthetic medicines are used. These drugs may cause allergy, dose-related or intravascular toxicity, seizures, arrhythmias, circulatory problems, nerve injury, haematoma, fainting or inadequate pain control. This information does not mean revision is planned under local anaesthesia; I perform revision rhinoplasty under general anaesthesia.

1. Material intolerance. Sutures, packing, splints or other materials may cause discomfort and require removal.
2. Infection around materials. Medicines or removal may be required.
3. Foreign-body reaction. Tissues may react to a material, requiring removal or replacement.
4. Displacement. An implant or supporting material, if used, may shift or rotate and affect shape or function.
5. Tissue thinning or erosion. Materials may thin or erode surrounding tissue and become visible. Removal and tissue repair may be needed.
6. Material-related pain. Pain around materials may persist or become chronic.
7. Material allergy. Itching, redness, swelling or a rash may require treatment.
8. A blocked sensation. Internal materials may affect airflow and the sensation of breathing.
9. Bleeding during removal. Removing packing or similar materials may cause bleeding.

Medicines do not all carry the same risks. Type, dose, route, interactions and individual health determine assessment.

1. Severe allergy and anaphylaxis. Swelling of the face, lips, tongue or throat, breathing/swallowing difficulty, widespread itching, low blood pressure and shock may occur.
2. Nervous system toxicity. Dizziness, numbness, tinnitus, changes in vision/hearing/speech, muscle twitching or seizures may occur.
3. Serious neurological problems. Depending on the drug and route, reported serious problems include nerve injury, sensory loss, weakness, loss of movement, paralysis or inflammation of membranes around the nervous system.
4. Heart, breathing and other organ effects. Blood pressure/pulse changes, arrhythmias, cardiac arrest, respiratory depression, nausea, vomiting, urinary retention or liver-test changes may occur.
5. Difficulty urinating. Temporary difficulty or a need for a urinary catheter may occur.
6. Antibiotic adverse effects. Nausea, diarrhoea or allergic rashes may develop.
7. Painkiller and anti-inflammatory adverse effects. Stomach irritation, burning or bleeding risk may occur.
8. Nasal spray and drop problems. Dryness or burning may occur. Prolonged or inappropriate use of certain products can sustain or worsen obstruction.
9. Bleeding with blood thinners. Bleeding risk may increase. Use or interruption is coordinated between the relevant doctors.
10. Infection risk with steroids. Systemic steroids in particular can alter immune responses and increase infection risk.
11. Delayed wound healing. Some steroid treatments may delay healing.
12. Raised blood glucose. Systemic steroids may increase glucose, requiring additional monitoring in diabetes.
13. Stomach problems. Some steroid treatments may cause gastritis or ulcers.

• Graft warping or shape change. Cartilage may bend over time and affect appearance or the airway.
• Partial graft resorption. Graft support or volume may decrease.
• Displacement and visibility. A graft may shift, become palpable or show beneath the skin.
• Donor-site problems. The ear, chest or another donor area may develop scars, asymmetry, pain, bleeding or infection. Rib harvesting may injure the pleura.
• Scarring and support changes. New scar tissue, contraction or adhesions may develop, with persistent shape or breathing problems.
• Further revision. More grafts, medicines, hospital treatment or another operation may be needed. Later interventions do not guarantee the desired result either.