What You Need To Know About Liquid Rhinoplasty
Are you looking to improve the contour of your nose without going under the knife? You’re not alone. Non-surgical nose jobs, also known as liquid rhinoplasty, have become a sensation in recent years, with increasing numbers of patients seeking to solve their dorsal dilemmas with no downtime. Technically speaking, the procedure isn’t a rhinoplasty at all; it’s dermal filler (usually hyaluronic acid) non-surgically injected into the nose. The implicit promise in this procedure is a seemingly easy fix for a very common cosmetic complaint.
According to Los Angeles plastic surgeon Jason Roostaeian, MD, requests for non-surgical rhinoplasties are on the rise due to increased exposure on social media. “As more people talk about it and see it posted, of course everyone becomes interested,” he says. “If they think they can get a good result without committing to a full surgery, then it’s enticing.”
Non-surgical rhinoplasty procedures involve strategically injecting filler into nasal valleys and curves to create the illusion of a smoother contour. To determine whether a person is a good candidate for the procedure, Beverly Hills plastic surgeon John Layke, MD, looks for several factors. Liquid nose jobs, he says, are performed “to correct a dorsal hump, to raise a drooping tip, to fill in contour irregularities (usually from a previous rhinoplasty),” and to correct minor nasal asymmetries or crookedness. For patients who are considering surgery but aren’t prepared to take the plunge, Dr. Layke says nasal filler allows you “to see the effects of improving the overall appearance of your nose without permanency. This way patients can try out their new nose to see if they like it.”
Patients with functional concerns, however, are not good candidates for nasal filler. As Dr. Layke explains, “Breathing issues cannot be corrected without surgery.” Dr. Jason adds that non-surgical rhinoplasty is also not ideal for those seeking dramatic or permanent changes, looking to fix a severely crooked nose, or hoping to correct a wide nasal base.
According to Dr. Jason, this treatment that’s taking the aesthetic business by storm has some other serious drawbacks. It has both limited potential to produce pleasing results and a serious set of risks. “With filler, we can only add - we have to make the nose larger,” he says. “It’s physically impossible to shrink a nose with filler.” For this reason, Dr. Jason cautions people to look critically at the size of the nose in before and after pictures. “It’s common for injectors to use photo trickery, where the ‘before’ is a closeup and the ‘after’ is taken a bit farther away to create an illusion that’s not actually achievable.”
Using injectable filler to alter the nose can also create an inconsistent result, says Dr. Jason, because “it dissolves all the time, so you’re chasing your tail trying to maintain it. The nose is very structural - it doesn’t make a lot of sense to add a gooey gel and expect it to look right.” This is especially true when addressing the nasal tip, he explains, because there, “the cartilage should be close to the skin. Pleasant looking noses have a bit of that underlying structure lending it substance visually.” Adding filler to the tip can sometimes result in simply exchanging a droopy appearance for a puffy one.
More concerning, however, are the potential complications associated with injecting filler into the nose since it has a high concentration of blood vessels. According to Dr. Jason, it’s crucial for people to seek out a highly trained injector, ideally a board certified plastic surgeon, to perform any kind of dermal filler cosmetic procedures. If filler is inadvertently administered into a vessel that leads to the eyes, irreversible blindness can occur without warning. More commonly, nasal filler carries a risk of skin death (known as necrosis), which happens when tiny blood vessels, like those along the sides or tip of the nose, become blocked with gel. According to Dr. Jason, the warning signs are usually immediately apparent and include skin discoloration or a blotchy, mottled appearance that’s distinctly different from typical bruising. “While you may safely see a slight purple elevation right where you were injected, seeing splotchy color away from the injection site isn’t good,” he says. A lack of color near the surface of the skin is also concerning. “When you press on normal skin, it turns white,” he explains, “and then when you release the pressure, it quickly turns pink again. You should be able to see that redness coming back right away.”
Because of the potential complications and the limited aesthetic potential, Dr. Jason performs non-surgical nose jobs infrequently. For those patients committed to avoiding rhinoplasty surgery for health or other reasons, he recommends dermal filler to correct a mild hump as long as the patient isn’t concerned about nasal width. Injecting filler “can make the hump look smaller,” he points out. “It’s an optical illusion: if you add filler in the valley, the mountain doesn’t look as big.”
Non-surgical rhinoplasty typically costs around $1000 - $2000 and takes about 10-15 minutes to complete. About twenty minutes before the procedure begins, the surgeons apply a topical numbing cream to make patients more comfortable. Dr. Layke usually starts with adjustments to the nasal tip (if applicable) before addressing the bridge of the nose, while Dr. Jason uses the same “top down” approach he takes during his surgical rhinoplasties. While patients may experience minor bruising and swelling at the injection sites for a couple of days, cold compresses help minimize their appearance. Dr. Jason encourages patients to avoid both strenuous exercise (which elevates blood pressure) and blood thinners like ibuprofen, aspirin, or alcohol for 24-48 hours after receiving dermal filler injections. Everyone metabolizes filler differently, so results last about one year, but may begin to diminish as early as six months. If a patient is unhappy with their non-surgical rhinoplasty, Dr. Layke says that “Hyaluronidase can be injected to dissolve the product and return them to their pre-injected state.”
Whether you opt for a traditional or a non-surgical rhinoplasty, Dr. Layke urges patients to confirm that their surgeon is board certified by the American Board of Plastic Surgery or the American Board of Facial Plastic Surgery. “Make sure you feel comfortable with that surgeon, as they must be able to manage potential complications,” he says. “Look at their results to ensure that their ‘aesthetic eye’ matches yours.” Dr. Jason adds, “Be diligent about examining standardized before and after photos. Those patient selfies aren’t accurate - what you can do with lighting and makeup completely changes the apparent result. What may look fine from one perspective could look terrible from every other view. When you're evaluating a plastic surgeon’s work, make sure that the result looks good from every angle."