Subcutaneous emphysema (SE) is a notably rare complication of surgical procedures, particularly in the context of rhinoplasty. In this report, we present a novel case of recurrent nasal SE following routine open septorhinoplasty in a 59-year-old male. This patient developed persistent subcutaneous air over the nasal dorsum, linked to a fistula tract to the nasal vault, despite initial conservative management with needle aspiration. The patient required surgical intervention to repair the mucosalized fistula tract, leading to a successful long-term outcome. This case highlights a significant gap in the current understanding of SE, as previous reports have primarily focused on periorbital involvement rather than nasal SE and underscores the importance of recognizing nasal SE as a potential complication of rhinoplasty.

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