Basically, anything non-surgical, or liquid is exploding in popularity in my office right now. The most popular of the popular is the liquid rhinoplasty. Liquid rhinoplasty is a procedure that uses Botox and facial filler injections to change the shape of the nose. At this time last year, I was performing about one liquid rhinoplasty per month. Now, it’s more like two or three per week!
In this liquid, non-surgical procedure, a combination of Botox and facial fillers are injected to achieve the desired result without a scalpel. In the right candidate, a liquid rhinoplasty can even out irregularities along the bridge of the nose, make the nose appear straighter, raise the nasal bridge, or camouflage a dorsal hump on the profile view. Although you are technically adding volume with filler, the end result is often a nose that appears smaller and more refined. The idea is to change the way light hits your nose, creating a kind of semi-permanent contour makeup on your nose. During a liquid procedure, ice is used to numb the skin, and small needles are used to inject filler and/or Botox.
Not all nose concerns are amenable to liquid, non-surgical, rhinoplasty, but if you’re among the lucky (or unlucky, depending upon how you look at it) for whom this procedure can work, you can skip the pain and recovery of surgery. Results are dramatic and instant, and so are the savings! As compared to surgery, non-surgical rhinoplasty saves time, money, and pain. For most patients, there is essentially no downtime. The major downside is that the procedure is not permanent – depending on the filler selected, the results generally last from 1-2 years. Sounds like a good deal, no?
It is important to note, however, as we become more accepting of the idea of being poked and prodded with needles as a part of our routine beauty upkeep, that all of these injections, while effective, and amazing when done properly and subtly, are not without risk.
Vascular compromise leading to skin necrosis (actual death of skin because of decreased blood flow to the area) is the dreaded risk of non-surgical rhinoplasty. It can either occur from filler material actually getting into blood vessels, or from filler material pushing on blood vessels under the skin. While appropriate training and experience can help to minimize the risk of this occurring, the risk is never zero.
Studies have shown a rate of vascular compromise after filler injection of approximately 0.05% even in the hands of highly trained physician injectors. That equates to approximately 1 in 2000 times that facial filler injections are performed in the nose. Thankfully, vascular compromise is exceedingly rare, and when treated promptly and correctly, will resolve without long-term consequences. But that is the key – it must be attended to swiftly and expertly. If not treated appropriately, long-term consequences can be serious.
This is the reason that you should always ALWAYS be sure that your injector is properly trained, and knows how to handle vascular compromise after filler injection, whether they have personally experienced it first hand or not. All physicians who inject hyaluronic acid fillers like Juvederm, Restylane, Perlane and Belatero, should be stocking hyaluronidase in their office (this is the enzyme that breaks down the hyaluronic acid fillers used for liquid rhinoplasty).
Bottom line: While non-surgical rhinoplasty can be amazing, and is often quick, easy, and effective 1,999 out of 2,000 times, it is not without risks. Choose a plastic surgeon or dermatologist who is well trained, competent, approachable and responsive to you and your concerns.