The surgical maneuvers employed in aesthetic rhinoplasty can result in unforeseen structural complications that lead to an unsatisfied patient. Many of these problems arise years after the primary surgery and include both aesthetic and functional losses. Contemporary rhinoplasty should always be designed with long-term perspective and an eye on possible untoward outcomes. This article discusses the anatomic and physiologic basis of rhinoplasty complications with a focus on primary rhinoplasty principles that will prevent their formation.