Warning Signs After Rhinoplasty

If this is happening now

The list below needs a doctor who can examine you, on the day, wherever you are. It is not a diagnosis and this page cannot triage anyone.

• Difficulty breathing, or breathing that is getting worse rather than easier.
• Bleeding that will not stop, or heavy bleeding that starts again.
• Redness or swelling of the face spreading beyond the nose.
• A high temperature, shivering, or feeling generally unwell.
• Any sudden change in vision, or pain around the eye.
• Severe pain, or pain increasing while you are taking the analgesia you were given.
• Chest pain or breathlessness, which needs emergency assessment whatever the cause.

Say that you have had nasal surgery, and when. Take the operation note and the list of medicines you were given, if you have them.

See someone today

These need someone who can look inside the nose, the same day. Message the clinic as well, but do not let a reply you are waiting for take the place of an examination.

• A temperature, or discharge from the nose or an incision that has a smell.
• Redness or tenderness at the columellar incision that is spreading rather than fading.
• Swelling or bruising that starts increasing again after it had begun to settle.
• Increasing pressure or blockage inside the nose, particularly on one side.
• A splint, dressing or packing that has come loose or come away earlier than planned.

Infection is one of the recognised risks of the operation. In one multi-institutional analysis of 835 patients, superficial incisional infection was recorded in 1.1 percent. Reoperation was recorded in 2.3 percent.

Those are small percentages in one series, not a prediction for any individual, and neither figure tells you what a particular symptom means.

Raise at your next appointment

These belong at a scheduled review rather than an urgent visit. Nothing here is a reason to wait if it is getting worse, and none of it has to be saved up until the appointment.

• Numbness at the tip or upper lip that is not improving.
• Any change in your sense of smell.
• An irregularity or asymmetry that has appeared as swelling resolved.
• The columellar scar, if it stays raised or red as it matures.
• Whistling, persistent crusting, or bleeding from inside the nose.
• Dissatisfaction with the shape, which is a clinical conversation and not a complaint.

Large septal perforations can cause crusting, bleeding, whistling and obstruction. Perforation is reported after septoplasty in 0.5 to 3.1 per cent of cases in published series.

What a recognised risk is

Recognised means published as a known outcome of the operation. It does not mean expected, and it does not mean it should be watched at home rather than examined.

• Bleeding, infection and the general risks that accompany any operation under general anaesthesia.
• Persistent swelling, particularly at the tip and particularly in thicker skin.
• Asymmetry, or a contour irregularity that becomes visible only as swelling resolves.
• Altered or reduced sense of smell, which is usually temporary but can persist.
• Numbness of the nasal tip or upper lip, which commonly improves over months.
• Difficulty breathing through the nose, which can occur even when the airway was not the reason for surgery.
• Scarring at the columella after an open approach. Usually inconspicuous once mature, but it is a real scar.
• Dissatisfaction with the aesthetic result, and the possibility of needing revision surgery.

The NHS lists breathing difficulty that is usually temporary but occasionally permanent, alongside nosebleeds, excessive bleeding, blood clots, infection and a reaction to the anaesthetic.

When the surgeon is in another country

The weeks after the flight home are the ones with no clinic within reach. Settle this before surgery: which named person answers a clinical question once you are home, in what language, and how fast.

A booking coordinator on a messaging app is not that person, and neither is a website. If anything on the first list appears, the local emergency department is the destination and the clinic is the second call.