Lateral osteotomies performed during cosmetic rhinoplasty can be associated with several complications. Due to the proximity of the lacrimal drainage system to the site of lateral osteotomies, the lacrimal system may be injured during this procedure. This type of injury is very rare, with few reports in the literature. The authors describe a 31-year-old woman who underwent a cosmetic rhinoplasty and experienced postoperative recurrent conjunctivitis with purulent discharge and epiphora. A lacrimal fistula developed 10 years after the procedure.