Complications in surgery are divided into general and procedure specific and the rhinoplasty is no exception to this rule. Here we will focus on procedure specific complications related to rhinoplasty.

Perhaps the most catastrophic complication in rhinoplasty surgery would be the risk of CSF (Cerebrospinal Fluid) leak. This can happen during any surgery that involves manipulation of the nasal septum. This delicate bone is connected to the floor of the anterior skull through which tiny branches of the olfactory nerve convey our sense of smell and contribute to fullness of taste. If subtle manipulation results in a small fracture and breach of the dural envelope encasing the brain, a direct communication between the outside world and our brain is established. The fluid encasing the brain and the skull (CSF) can then leak out and discharge through the nose. This is often seen as a clear discharge which can only be identified as CSF through testing for beta2 transferrin, a protein only found in the CSF. In rare cases where this happens a real and potential risk of meningitis needs to be addressed by seeking appropriate neurosurgical input.

Another complication which can be confused with the CSF leak is damage to the tear ducts. This will also results in clear fluid discharge from the nose and without testing for the above protein, it is impossible to distinguish the two. The tear ducts communicates and ultimately drains into the nasal passage by making their way through the lateral part of the upper nasal walls. Any fracture or manipulation of these can result in their disruption and consequently discharge through the nose. Where this happens, after ruling out a CSF leak, a lacrimal leak will often be self-limiting and does not require any surgical procedure.

Asymmetry remains a real risk in any form of aesthetic surgery and the nose is no exception to this. Any preoperative asymmetries need to have been pointed out and accounted for with surgical planning taking remedy of these into consideration. However, some residual asymmetry is not at all uncommon.

An inverse V shape deformity may happen where over resection and inadequate support for the middle part of the nose results in collapse of the middle vault and effectively giving an inverse reshape deformity on frontal view.

Sense of smell which is not all too infrequently affected by the surgery may in fact be permanently damaged. This is something that needs to be discussed with all patients.

Finally, skin necrosis of the nose may result from the trauma of surgery.

Dr Ross Farhadieh

Dr Farhadieh is an internationally renowned Australian qualified and trained Plastic Surgery. He holds fellowship qualifications in Plastic Surgery from Royal Australian College of Surgeons, Royal College of Surgeons (England) as well the European Board of Plastic Reconstructive Aesthetic Surgery. He has multiple clinical subspecialty fellowships in Cosmetic, Pediatrics as well as Microsurgery from World Leading institutes in London.


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