The latest evidence on rhinoplasty risks and complications: a mini-systematic review and meta-analysis round-up (2024–2025)

How we selected the evidence: What “latest 5” means

We searched PubMed for the most recent (2024–2025) systematic reviews and meta-analyses related to rhinoplasty complications and risks. From the latest five studies, four were meta-analyses, and one was a large comparative review of open vs closed rhinoplasty risks.

These sources formed the basis of this synthesis. Numerical data were extracted directly when available, and qualitative findings were summarized to describe the spectrum of complications after rhinoplasty.

What complications do recent meta-analyses highlight most?

Across these recent studies, rhinoplasty risks cluster into a few key categories – including bleeding, infection, cartilage resorption, implant extrusion, and revision surgery. Each meta-analysis provides insights into rhinoplasty complication rates and the factors influencing outcomes.

Bleeding and hematoma: Intraoperative blood loss and postoperative hematoma

A meta-analysis of randomized controlled trials found that preoperative intranasal desmopressin (DDAVP) significantly reduces intraoperative bleeding (mean difference −15.22 mL; 95% CI −19.52 to −10.93; I² = 0%). This evidence confirms that controlling bleeding is crucial to lowering rhinoplasty risks such as hematoma and prolonged edema. Although rhinoplasty risks death are extraordinarily rare, blood-related complications remain a central safety consideration.

Infection, extrusion and foreign-body reaction

These complications of rhinoplasty are primarily linked to implant materials. A 2025 systematic review and meta-analysis reported lower complication rates with expanded polytetrafluoroethylene (e-PTFE) compared to silicone.

• e-PTFE: lowest rhinoplasty complication rate, with secondary deformity ≈ 2% and resorption ≈ 0.6%.
• Silicone: slightly higher rhinoplasty risks and complications, including scarring (~2.7%) and extrusion (~1.2%).

Autologous grafts (such as cartilage or bone) carry minimal foreign-body reaction but may introduce rhinoplasty risks and side effects like donor-site pain or scarring.

Resorption, warping and revision risks

A 2024 SR/MA showed that severely crushed cartilage has substantially higher rhinoplasty complication rates – resorption (3.4%) and revision (17.9%) – compared to non-severely crushed cartilage (0.9% and 3.5%, respectively). Such findings emphasize the structural rhinoplasty risks associated with aggressive graft manipulation.

Technique choice: Open vs closed. Do rhinoplasty risks differ?

The 2025 SR/MA confirmed that rhinoplasty complication rates – including bleeding, infection, and scarring – did not differ significantly between open and closed procedures. This suggests risks with rhinoplasty are influenced more by surgical precision and patient anatomy than by technique choice.

Select the approach based on anatomical needs and surgeon expertise rather than perceived safety differences.

Graft and implant materials: Where do rhinoplasty complications cluster?

A large 165-study meta-analysis (2025) compared autologous and alloplastic graft materials to evaluate rhinoplasty risks and complications.

• Expanded polytetrafluoroethylene (e-PTFE or Gore-Tex) showed the lowest rhinoplasty risk profile, with only about 2% secondary deformity and minimal resorption (0.6%), swelling (0.8%), and deviation (1%), confirming its excellent safety and stability.
• Silicone implants have a high success rate of about 99.9%, but they present notable rhinoplasty risks and side effects such as scarring (~2.7%) and extrusion (~1.2%). Despite their popularity, they are linked to a higher rate of rhinoplasty complications compared to e-PTFE.
• Autologous cartilage or bone grafts provide excellent biocompatibility but carry rhinoplasty risks at donor sites, with auricular complications reported up to 33.3%, bruising around 25.5%, and edema about 14.3%, depending on the technique used.

Cartilage handling: The “crushed cartilage” question

In a focused 2024 SR/MA (11 studies; 1,132 patients), severely crushed cartilage was associated with:

• Resorption: 3.4% (vs. 0.9% in non-severe)
• Revision rate: 17.9% (vs. 3.5%)

This highlights the structural rhinoplasty risks of aggressive cartilage manipulation. Covering grafts with fascia did not significantly change outcomes. Avoid severe crushing whenever possible to reduce rhinoplasty complication rates and need for revision.

Bleeding prevention: Does DDAVP reduce rhinoplasty risks?

A 2024–2025 SR/MA (4 RCTs; 262 patients) showed that preoperative intranasal DDAVP reduced total blood loss by ~15 mL and improved surgical visibility (I² = 0%). While not a direct “complication rate,” this evidence supports DDAVP’s role in minimizing bleeding-related rhinoplasty risks – a critical factor in patient safety.

Age-related risk: Pediatric rhinoplasty risks

A 2025 pediatric SR/MA of 27,840 cases found higher rhinoplasty risks and complications in septorhinoplasty compared with septoplasty among children. Overall, pediatric septoplasty maintained low complication and revision rates. These results underline the importance of conservative planning and timing to avoid long-term rhinoplasty complications in developing nasal structures.

Overall rhinoplasty risk profile: What this means for practice

Synthesizing these findings:

• Technique: Open vs closed has no significant difference in rhinoplasty complication rate.
• Materials: e-PTFE offers the lowest rhinoplasty risks statistics; silicone and autologous materials carry distinct, predictable risks.
• Cartilage handling: Avoid over-crushing to prevent long-term rhinoplasty complications.
• Perioperative care: DDAVP effectively reduces bleeding-related rhinoplasty risks.
• Age considerations: Pediatric septoplasty is relatively safe, while pediatric septorhinoplasty requires additional caution.

Bibliography: The 5 latest PubMed-indexed articles considered

• Abi Zeid Daou C, et al. Outcomes of Open Versus Closed Rhinoplasty: A Systematic Review and Meta-analysis. PRS Global Open. 2025. PubMed PMID: 40771258.
• Patel RK, et al. Assessing the Safety and Efficacy of Pediatric Nasal Surgery: A Systematic Review and Meta-Analysis. Facial Plast Surg. 2025. PubMed PMID: 40763773.
• Gutierrez RWH, et al. Preoperative Desmopressin for Bleeding Reduction During Rhinoplasty. [Journal]. 2024. PubMed PMID: 40456991.
• Shafik AG, et al. Outcomes and Complication Rates of Different Materials Used for Nasal Dorsal Augmentation in Septorhinoplasty. Egypt J Otolaryngol. 2025;41:49.
• Wells MW, et al. Complications Associated with Crushed Cartilage in Rhinoplasty: A Systematic Review and Meta-analysis. J Plast Reconstr Aesthet Surg. 2024.