How is nose filler different from nose surgery?

What is nonsurgical rhinoplasty?

Nonsurgical rhinoplasty is a way of refining the contours of the nose by injecting filler without any incisions, and it is also called liquid rhinoplasty. According to a 2022 literature review, this method was first documented in 2006, and interest in it has grown greatly among both patients and doctors over the past 10 years ^[2].

The same review noted that in the United States, filler injections are the second most commonly performed nonsurgical (noninvasive) cosmetic procedure, accounting for about 26% of all noninvasive procedures ^[2]. It also stated that in the United States, injecting filler into the nose is an off-label use (a use outside the approved indications) ^[2]. This reflects the situation in the United States, so it cannot be assumed to be the same as treatment practices or regulations in Korea.

What filler can change

Hyaluronic acid fillers are used in several areas of the nose ^[2]. Because filler reshapes by adding volume, if there is a bump on the nasal bridge, the bump itself is not shaved down. Instead, volume is added above and below it to even out the height ^[2].

A 2023 literature review considered that, as filler technology and injection techniques have advanced, nonsurgical rhinoplasty has become a reasonable option for well-selected patients, both for first-time rhinoplasty and for revision ^[3]. The key condition here is that the patients are well selected.

• Evening out the height of a bump on the nasal bridge
• Filling noticeably hollow areas
• Correcting asymmetry in the upper and middle parts of the nose
• Refining a nasal tip that looks low or not lifted enough

How is it different from nose surgery?

When used appropriately, nonsurgical rhinoplasty may involve less recovery time and lower costs than surgery, and it can be a way to get a preview of how surgery might feel later on ^[1]. Nose surgery, on the other hand, is described as inherently difficult surgery because the structures are complex and it affects both function and appearance ^[5].

Cartilage forms the framework of the lower two-thirds of the nose, and this cartilage is essential for supporting the nose over the long term and keeping the airway open ^[6]. In surgery, methods that transplant the patient's own cartilage are mainly used, but there are limits to how much can be obtained, its quality, and the burden on the area where it is harvested ^[6]. Filler is not a way to change these structures themselves, so you should first check whether the change you want can be achieved by adding volume.

Rare but serious risks

Nose filler injections can be performed safely, but in rare cases, tissue loss, irreversible tissue ischemia, and irreversible blindness can occur, so these must be explained before treatment ^[1]. A 2020 literature review named the area between the brows and the nose as one of the vascular danger zones of the face, and explained that blood vessel damage can lead to tissue necrosis (death of tissue) and, in rare cases, cause loss of vision ^[4].

A literature review of revision rhinoplasty pointed out that the artificial materials commonly used to raise the height of the nose, whether solid or injectable, can lead to serious consequences ^[6]. Even if nose filler seems simple, that does not mean the risk goes away.

If complications occur, and prevention

For problems caused by hyaluronic acid filler, hyaluronidase treatment may be partially effective when signs and symptoms are detected early ^[1]. However, the same review emphasized that the best approach is still prevention ^[1].

A 2022 literature review considered knowledge of the surgical anatomy of the nose and the ability to manage complications to be critical for safe results ^[2]. Recognizing the danger zones and using appropriate injection techniques and fillers are presented as conditions for safety ^[4].

What to check during your consultation

Along with prevention, a 2022 literature review emphasized seeing an experienced, qualified doctor who specializes in rhinoplasty ^[1]. The shape of the nose, the skin, and the history of previous procedures differ from person to person, so whether filler or surgery is right for you should be decided after an examination.

• Whether the change you want can be achieved by adding volume
• Any history of previous nose surgery or filler treatment
• The ingredients of the filler to be used and the injection areas
• How a vascular complication will be handled if it occurs
• Symptoms that require you to contact the clinic right away after treatment