Unlike many other facial plastic surgery procedures, there are few non-surgical alternatives to rhinoplasty surgery. The only way to make permanent nose shape changes is to alter the underlying bone and cartilage framework. Such alterations ultimately get reflected on the outside as the nasal skin adapts.
The only non-surgical treatment option to help change the shape of the nose are injectable fillers. While not able to create any reductive effect, injectable fillers can selectively add volume or shape to the nose. It is most commonly used to help hide a hump or bump in the nose by injecting above it to smooth out the dorsal line. They can also be effective for filling in any irregularities or asymmetries after rhinoplasty surgery.
But placing injectable fillers into the nose is not without the risk of some complications. Unlike when fillers are placed around the rest of the face, the nose is really an ‘island’ when it comes to its blood supply. While the nose has a normally resplendid number of blood vessels feeding it, the risk of skin necrosis is very real. Most of the blood vessels supplying the nose are located on it sides and along the alar crease. Thus injecting into the side of the nose should be avoided to prevent potential occlusion of its arterial inflow. Injections into the nose are most safely done along the midline, anywhere from the radix down to the tip.
Avoiding these vessels is also important to prevent the most serious complication of injecting into the nose…blindness. Inadvertent injection into a blood vessel that may ultimately drain or flow into the back of the eye can cause optic nerve injury from embolization.
Besides restricting the location of the injections to the nasal midline, the type or properties of the injectable filler is also important. Only lower viscosity hyaluronic acid-based fillers should be used and thinned with local anesthetics if necessary. Thicker or higher viscosity fillers are more prone to risks of skin necrosis and blindness due to the high pressures that must be exerted to place them into the tight nasal spaces. (compression necrosis)
An injectable rhinoplasty approach can be done safely if hyaluronic fillers are used, injections stay in the midline and low volumes of filler are placed.
Dr. Barry Eppley
Indianapolis, Indiana