Signs of Bad Rhinoplasty: How to Recognise a Failed Nose Job

Not getting the expected result or encountering unwanted problems after aesthetic nose surgery (rhinoplasty) can be disappointing for patients. Bad rhinoplasty is when the surgery does not meet both aesthetic and functional goals. This may mean that significant problems remain in the appearance of the nose or new problems occur instead of improvement in breathing.

For example, if the nose remains curved, collapses, looks disproportionate or breathing difficulties persist after surgery, it may indicate a failed result. In this article, we will discuss what a failed rhinoplasty is, what symptoms it manifests itself with, how long these symptoms can be considered permanent and what are the signs of complications compared to the normal healing process. We will also talk about these symptoms described in medical sources and example situations that may require revision rhinoplasty.

What is a Bad Rhinoplasty Surgery?

Bad rhinoplasty is when a nose surgery does not give the desired aesthetic result or causes new health problems in the patient. Minor swelling, bruising and changes are normal after each surgery; however, if the nose is still far from the desired appearance after a certain period of time or breathing problems have occurred, this may be considered a failure of the operation.

In other words, the goals set by the surgeon and the patient before the operation could not be achieved, and sometimes the nasal functions and appearance may have become worse than before the operation. In the scientific literature, this situation is referred to as 'bad rhinoplasty' and a second operation may be considered for correction.

As a matter of fact, it is reported that such a need arises in a certain proportion of patients undergoing revision rhinoplasty (second correction surgery) due to respiratory problems or aesthetic dissatisfaction after the first surgery.

For example, according to a study, 5-15% of patients after the first rhinoplasty required revision surgery due to significant deformities.

Signs of Bad Rhinoplasty

The most common symptoms of a bad rhinoplasty occur both in the form of defects in appearance and health problems:

1. Unexpected aesthetic changes: Unpleasant or unexpected changes in the shape of the nose are observed. For example, asymmetry at the tip of the nose, collapse or protrusion on the back of the nose, irregularities in the arch area or tip are within this scope.

An unnatural nasal appearance that is incompatible with the patient's face may be an indicator of failure.

2. Breathing problems: The emergence of complaints such as new nasal congestion, ongoing breathing difficulties or snoring after surgery is an important sign. A successful rhinoplasty should provide both aesthetic and functional improvement; if the patient cannot breathe comfortably after surgery or if previous problems are not resolved, this indicates that the surgical intervention did not produce the desired result.

In particular, improper fusion of the internal structures of the nose or excessive tissue removal can lead to narrowing of the airway and cause such breathing problems.

3. Pain or discomfort that does not decrease: Pain is expected for the first few days after rhinoplasty, but it should decrease and disappear over time. If the pain persists or gradually increases after weeks, this is not normal.

Persistent pain or tenderness suggests that there may be an internal complication (such as infection or nerve damage) and is a sign that the operation was not completely successful.

4. Prolonged swelling and bruising: Postoperative swelling and bruising are normal in the first few weeks after the operation, usually significant bruising disappears within 1-2 weeks and most of the swelling subsides within a few months. However, if there is persistent swelling, stiffness or discolouration even after a few months, this may indicate that the healing process is going worse than it should be.

Especially if the oedema at the tip of the nose does not go away for more than a year, it may mean that the tissues have not recovered as expected.

5. Wound healing problems: Failure to close the incisions inside or outside the nose in a normal time, reopening of the sutures, continuous crusting or discharge are also signs of failure. For example, if an infection develops at the site of the surgical incision and the wound does not heal, this indicates an underlying complication (e.g. infection, tissue rejection). Normally, the nasal mucosa and skin incisions heal largely within a few weeks; a wound area that remains open longer than expected should be taken seriously.
6. Other problems: More rarely, complications such as permanent numbness (numbness in and around the nose), permanent changes in the sense of smell or septum perforation (a hole in the septum separating the two nostrils) may also indicate a failed outcome.

If a septum perforation occurs, the patient may complain of nosebleeds, a whistling sound when breathing or crusting. These types of problems are usually unexpected situations that should not be seen after rhinoplasty.

If one or more of the above symptoms are present, it may be considered that the rhinoplasty surgery has not achieved the desired success. In this case, the patient should consult his/her doctor immediately and have the necessary examinations performed. Depending on the severity of the problems, the doctor may recommend medical treatment or plan correction with revision surgery.

It should not be forgotten that a second operation will usually be more complex than the first, so the decision to revise should be carefully evaluated by the patient and the surgeon.

Normal Healing Process or Symptom of Complications?

Every change experienced after rhinoplasty surgery should not immediately cause panic. We can make some comparisons to understand which findings are included in the normal healing process and which ones indicate a complication:

Normal healing symptoms

Swelling and bruising: Bruises and swelling on the face are usual for the first 1-2 weeks; the nose and its surroundings may be oedematous. Swelling is more pronounced especially in the morning and may decrease during the day. Swelling that decreases over time and slight asymmetry is normal.

For example, if one nostril appears temporarily more swollen than the other, this usually resolves.

Mild pain and numbness: A twinge in the first few days, which can be controlled with painkillers, is normal. There may also be mild numbness or tingling in the tip of the nose and teeth; these are due to the nerve recovery process and usually disappear within a few weeks.

Crusting and congestion: It is normal to have clots and crusts in the nose after surgery, and breathing may be difficult in the first weeks. Breathing gradually opens with regular nasal cleaning. The sense of smell may decrease in the first weeks, but it will return as the mucosa heals.

Tiny irregularities: In the first months, very small irregularities can be felt on the contour of the nose because the tissues are not fully in place. If these irregularities gradually improve and are not very noticeable from the outside, it is most likely a normal healing process. For example, a small bone protrusion that can be felt when touched may soften and disappear within months.

Signs of complications

Swelling that does not decrease or increases: Stubborn or even worsening swelling after weeks is not normal. Increased swelling, especially on one side compared to the other, may be a sign of infection or haematoma (internal bleeding).

Redness, warmth and discharge: Redness of the nasal skin and swelling with an increase in temperature indicate infection. Yellow-green discharge from the surgical site is also a sign of infection and requires medical intervention. In normal healing, the swollen area is usually not red.

Severe pain or sudden increase in pain: Severe pain that does not gradually decrease after the first week, but on the contrary increases, indicates a problem. In particular, a nose that is too sensitive and painful to touch indicates that there may be an abscess or infection underneath.

Persistent severe congestion: If breathing does not open within the first 1-2 months after surgery and severe nasal congestion persists, there may be an uncorrected deviated septum or a collapse in the nasal valve (airway opening). Normally, breathing should become easier as the swelling goes down; otherwise, complications are considered.

Distortions in the shape of the nose: Alarm bells ring if the shape of the nose looks worse instead of better as the healing progresses. For example, deformities such as a sunken nasal ridge, abnormally raised nasal tip or receding nostrils, which are not noticed at first but become evident when the oedema subsides, indicate structural problems that occurred during surgery.

Such deformities do not correct on their own and may require revision.

Symptoms of septum perforation: If a hole has formed in the septum, the patient may hear a whistling sound when breathing, and may experience chronic crusting and bleeding. This is not a normal condition, but a complication of rhinoplasty and usually requires surgical repair.

Permanent loss of smell or numbness: Very rarely, failure to return the sense of smell after surgery or permanent loss of sensation at the tip of the nose may be a sign of nerve damage.

These conditions are not normal and should be reported to the doctor.

To summarise, in the normal healing process, problems tend to get better every day, whereas in case of complications, problems either persist or worsen. As a patient, it is best to follow your body's signals and consult your doctor if you notice anything unusual.

Examples of Situations Requiring Revision Rhinoplasty

Some problems that occur after the first surgery may require a second nose surgery (revision rhinoplasty) for correction. The need for revision is usually recognised by the presence of the permanent symptoms mentioned above. Here are a few examples of conditions that require revision rhinoplasty:

Collapses on the back of the nose or excessive arched appearance: If too much nasal bone and cartilage tissue was removed in the first surgery, a collapse in the nasal profile (saddle nose deformity) may occur. Conversely, insufficient removal of the arch can also lead to a prominent humped appearance. Since these situations cause significant aesthetic problems, they may need to be corrected by revision.

Continued breathing difficulties: In cases where the septum is not sufficiently corrected, collapse occurs in the nasal valve areas or the nostrils are excessively narrowed by surgery, the patient suffers from permanent breathing difficulties.

For example, if the valve angle is narrowed due to collapses in the nasal structures, these structures are supported again with cartilage grafts in revision surgery. Cases where respiratory problems persist necessitate a functional revision intervention.

Significant deformities at the tip of the nose: After the first surgery, the tip of the nose may drop (the tip of the nose goes down due to lack of support) or, on the contrary, an excessively raised nasal tip may occur.

In addition, it is also possible for the tip of the nose to remain very pointed or splayed, showing marked asymmetry. This type of tip problems are aesthetically disturbing and are eliminated by cartilage shaping or grafting with revision.

Nasal wing and hole problems: Postoperative nostrils may become disproportionate; one hole may remain significantly larger or differently shaped than the other. Or there may be excessive narrowing and retraction of the wings of the nose (pinch deformity).

In this case, which also causes difficulty in breathing, a more symmetrical and functional structure is provided by placing grafts on the nasal wings or adding cartilage if necessary.

Septum perforation: In rare cases, a hole in the septum may have formed during the first operation and this hole may not heal spontaneously. Perforation of the septum causes dryness, crusting and bleeding from time to time. In revision surgery, patching of this hole (repair with a graft) may be considered.

General disproportion and incompatible nose with the face: Some patients may think that their nose is still too big or too small for their face after the first surgery.

If the nose is really inappropriate in a way that disrupts facial aesthetics (for example, a nose that is too small or still too large for the face), size and shape corrections can be made in revision surgery. Bony protrusions on the back of the nose and symmetry disorders are also included in this category.

The above conditions are the most common causes of revision rhinoplasty. For example, it has been reported in scientific publications that the most common cause of revision operations is pollybeak deformity (too high tissue just above the tip of the nose); the second most common causes are deformities of the nasal tip and curvatures in the nasal midline.

Although revision surgeries are technically challenging, experienced surgeons use various graft and repair methods to eliminate such problems.

The important thing is that the patient should not postpone it when he/she has a problem that may require revision, but should discuss it with his/her doctor and make a correction plan by waiting for the appropriate time (usually at least 9-12 months after the first surgery is recommended).