Liquid Rhinoplasty (Ep. 50)

So today we're going to talk about a topic that has really gained prominence here in the last couple of years, and that's liquid rhinoplasty. So doing a nose job just with soft tissue fillers. There's a lot of things that come up there that we need to talk about before you rush out and get your nose injected.

First of all, is it safe? Is it effective and what are the results not only in the long term, but what can you expect after a treatment with soft tissue fillers for rhinoplasty? One of the problems with surgical rhinoplasty is that the revision rate is between five and ten percent, kind of depending on who you read.

And that means one of every twenty, one of every ten patients who has a rhinoplasty is going to Now, fortunately, most of these revisions are small, but before the advent of soft tissue fillers, a lot of these things, as a patient, you had to either live with or go back to surgery to fix. Now, we see a lot of our Revisions from rhinoplasty unless it's something significant.

We can treat with soft tissue fillers. Little areas along the bridge of the nose that are a little bit depressed on one side. If we have a little something on the dorsum, that needs to be corrected. We can do that with soft tissue filler and save somebody a revision. On the flip side, we have patients who are interested in rhinoplasty, but either don't want or can't have surgery for one reason or another, and are looking to have something camouflaged, and those are the patients where liquid rhinoplasty or non surgical rhinoplasty is really beneficial.

What is a non surgical rhinoplasty? Simply, it is using filler to help camouflage places that you don't like and change the shape of your nose, either how far it sticks out, which we call projection, or camouflaging humps. Those are probably the two most common things that we can do with liquid rhinoplasty.

One thing as a patient that you have to understand is when we do a liquid rhinoplasty, we're adding to your nose. So your nose at the end of a liquid rhinoplasty is going to be... A little bit larger than it was when we started. So if you're one of these patients who already is uncomfortable with the size of their nose, feel that your nose is too large, a lot of times adding more volume to your nose to help hide a hump can make that problem a little bit worse.

So something to really consider when you're thinking about going to see somebody for a liquid rhinoplasty. Think it's important for you as the patient or prospective patient to understand that if you are looking for somebody to do liquid rhinoplasty, that you find somebody who does surgical rhinoplasty. Because, just like with non surgical facial treatments versus facelifts, You want to see somebody who knows and has the ability to do the entire spectrum of treatment options and can lay those treatment options out in front of you and will help you guide you to the right choice for you at the time and also be able to plan for later because what we don't want to do is do something now that will potentially impact future treatment options.

In the negative. So, see somebody who does rhinoplasty to talk about liquid rhinoplasty. There are a lot of talented injectors out there, but the anatomy of the nose is complex, and it's easy to veer off into tiger country and get in trouble with liquid rhinoplasty, either because you don't understand the anatomy or just don't know the anatomy.

The second pearl with liquid rhinoplasty is know what you're getting injected. You should really, in my opinion, only be using hyaluronic acid fillers for liquid rhinoplasty. These are, Dissolvable fillers, they, we have an enzyme hyaluronidase or hyalinex or vitrase that we can inject into those areas that we put filler and dissolve it, make it completely go away.

So if we don't like the way it looks, or God forbid, we have a vascular occlusion, which is something we really have to take seriously in the nose, then we can dissolve that filler and make that go away. So, permanent fillers in the nose are a no no. Stay away from those.

The other thing to consider with liquid rhinoplasty is that you have to understand what we can and can't do. So, like I said a little bit before, Liquid rhinoplasty is a great treatment option to camouflage a dorsal hump. So if you've got a hump and there's a depression in front or behind that hump, [00:05:00] we can camouflage that with filler and make that go away.

The caveat being that it does make your nose a tiny bit larger, but It takes away that hump. The second thing that we can do is improve projection or how far the tip of your nose comes out from your face. In people with short noses or noses that are more round at the tip, they want a more refined tip.

We can help build that up and make it a little bit more refined and less kind of bulbous and round with some filler. There are obviously limitations to that, and that's something that you really want to talk to whoever's doing your injections before to give you an idea of what to expect. The third thing we can do, and doesn't really fall into the filler category as much, but is part of liquid rhinoplasty, is for people whose, the tip of their nose droops when they smile or talk.

There are little muscles in your collumella, so this little place right here in between your nostrils, that some people have that are strong enough to pull the tip of their nose down when they smile. And by putting just a tiny bit of neurotoxin in there, Botox or Dysport, we can weaken that muscle and keep your nose from dropping when you smile.

Obviously, that's temporary, but is a non surgical treatment option for a droopy nasal tip.

Liquid rhinoplasty is very similar to any other injectable treatment that you get done. Typically, we'll use a little bit of topical anesthetic on your nose. It is an office procedure. It doesn't take much time. And, once the skin of your nose is numbed, we can inject our little bits of filler in the areas that we need it.

As a patient, always. Look at the result before you leave the office. I give my patients a mirror. We look at everything before you're done to make sure that we've accomplished our goals and you really want to make sure that you inspect your injectors results before you leave their office. We usually see people back a couple of weeks later once the, this very small amount of swelling has gone away just to make sure that there are no little indentions or areas that aren't.

Completely smooth and flat that we want to take care of. Filler in the nose tends to last a long time. There's no muscle pulling on that filler. And so it typically will last at least a year. And as that filler degrades over time, your body will leave a small bit of scar tissue there. And what we see is that year over year, we end up using less and less.

filler to accomplish the same result.

What are some of the problems with liquid rhinoplasty? Well, the biggest problem, the one that everybody is rightfully scared about is a vascular occlusion. So, you block blood vessels that go to the nose with your filler injections. Typically, these show up almost immediately and is something that you're injector will be watching for and can treat right there with some enzyme the hyaluronidase and that is the reason to use dissolving filler gears because it is safe and it's something that we can dissolve if we need to if there's a problem. The other thing that is much more common and easily fixable is a little contour deformity afterwards.

Typically, people don't get quite enough injected and that is a simple touch up at a couple of weeks once the swelling is gone. So, all in all, liquid rhinoplasty is safe. It is a great treatment option for a subset of patients who are interested in reshaping their nose.

And is something that is becoming more and more common over time. So I hope you've enjoyed this episode. As always, you can reach out to me through DM, send me an email, and look forward to seeing you on the next show.