Complications in Rhinoplasty: A Literature Review and Comparison with a Survey of Consent Forms

Abstract

Importance: Informed consent in rhinoplasty is a challenging process due to the technically demanding surgery with a wide array of potential complications. Objective: To underscore the significance of informed consent in rhinoplasty, its complications, and identify gaps in the consent process. Design, Setting, and Participants: Dual search and comparison. First a review of the literature for rhinoplasty articles was carried out between January 2000 and November 2017 with at least 100 patients to identify complications and their incidences. Then a comprehensive online search for rhinoplasty consent forms was carried out to identify consent form topics and their incidences. Main Outcomes and Measures: Consent form topics and complication rates from the literature review were reported and directly compared. Results: A total of 117 articles were included, with 36 different complications reported. Twenty-four consent forms were evaluated, yielding 80 different topics. Common complications within the literature included skin problems such as acne (18.3%), numbness (16.7%), hospital revisit (6.5%), primary source revision rate (5.3%), and dissatisfaction (5.0%). The most commonly covered consent topics included infection (100%), bleeding (95.8%), and scarring (95.8%). Unsatisfactory results and need for revision were only covered in 83.3% and 75.0% of consent forms, respectively, despite both being in the top 5 complications cited in the literature. Conclusions and Relevance: Rhinoplasty consent forms generally cover a wide range of topics, with varying incidences of complications cited within the literature. Certain complications such as dissatisfaction and revision surgery should be included in every consent process. These data help provide a contextual framework as well as valuable information in preoperative counseling for patients and physicians regarding rhinoplasty and its potential complications Level of Evidence: NA

The Effect of Hirodoid Cream on Ecchymosis and Edema around Eyes after Rhinoplasty

“… 1 The most important cause of this complication is vascular trauma at the site of osteotomy. 2 The extent and severity of these complications may be reduced by precisely observing surgical techniques, even they cannot be completely prevented. 2 , 3 …”

“…Also, the presence of ecchymosis (with greater intensity and extent) with prolonged discoloration causes post-inflammation hyperpigmentation (PIH), which can even create or intensify the black loop around the eye. 2 , 3 …”

“…1 The most important cause of this complication is vascular trauma at the site of osteotomy. 2 The extent and severity of these complications may be reduced by precisely observing surgical techniques, even they cannot be completely prevented. 2,3 These complications can prolong the convalescence of patients and, at the same time, they are of interest to the patient, his/ her relatives, and even to the physician, such that they sometimes frighten patients and their companions that would affect patient satisfaction.…”

“…Also, the presence of ecchymosis (with greater intensity and extent) with prolonged discoloration causes post-inflammation hyperpigmentation (PIH), which can even create or intensify the black loop around the eye. 2,3 In clinical trials, various methods have been employed trying to reduce these side effects, which are summarized as employment of steroids, adrenaline solution one per 100,000, ice bag, intravenous tranexamic acid, clonidine, herbal material such as Arnica, and topical use of vitamins K. 4 Since the above agents are not impeccable either due to systemic effects or limitations in results of administration, if pharmacological agents can be used, which have easier and especially topical use and reduce effectively edema and ecchymosis, they can be routinely used in clinical settings. 4,5 Hirodoid (heparinoid or HPS) has anticlotting, fibrinolytic and anti-inflammatory effects, and until now, no study demonstrated the impact of hirodoid in reducing edema and ecchymosis following rhinoplasty, although other studies outside the field of surgery has been undertaken.…”

The Role of Fibrinogen-Thrombin Coated Collagen Sponge (TachoSil) in Rhinoplasty: Our Experience.

“…Common complications of rhinoplasty were reported as acne (18,3), numbness (16,7%), hospital revisit (6,5%). [20] Early complications were as an abscess in 2 patients, seroma in one patient, small foreign body granuloma at the suture site in one patient, and postoperative nasal trauma in 2 Patients.…”