This study describes the complications seen after balloon sinuplasty (BSP) - a commonly performed procedure (particularly in the USA where it is often performed as an office procedure) versus traditional functional endoscopic sinus surgery (FESS). The data source was a national commercial insurance database and evaluated 2851 cases of BSP versus 11,955 cases of FESS. Interestingly the reported complication rate for BSP was 5.26%, and for FESS was 7.35% - which may seem surprising to those who consider BSP to be a relatively complication-free procedure. The complications listed following BSP include bleeding, orbital injury, CSF leak and pneumocephalus. Whilst the rates of all of these are slightly lower than for traditional FESS, they are not insignificant e.g. orbital complications 2.9% (vs. 3.47% in FESS), skull base/CNS complications of 0.35% (vs. 0.39% in FESS), bleeding 2.03% (vs. 3.46% in FESS). The finding also identified an increased risk of revision surgery following FESS rather than BSP which is four-fold - although does accept that there may be some bias in this finding, as those who undergo FESS rather than BSP are more likely to have more extensive disease. This is useful data, and should act as a cautionary tale, reminding us that even though a BSP is a less invasive method of opening the sinuses, the potential complications associated with the procedure remain the same, and patients should be counselled as such.