Will Injectables Make a Secondary Rhinoplasty More Difficult?

I had a silicone implant to augment my flat asian nose. But the implant looks very unnatural and I want it removed. I haven't decided what's the best look for my nose, however. I'm thinking about having the implant removed and try an injectable such as Juvederm or Radiesse, before having a secondary Rhinoplasty to permanently change my nose shape again.

Will Juvederm or Radiesse injections make the second nose surgery more difficult?

Doctor Answers (12)

Rhinoplasty is a complex procedure

+2

Reshaping of the nose is a complex procedure.  Previous nasal procedures (surgical or non-surgical) may increase the scarring of the tissues making the procedure more difficult. The skin soft tissue envelope of the nose is very delicate. .  If this is damaged it is difficult to improve and may limit the quality of the results any procedure can provide.  Implants may become infected and extrude.  The best advice is to have the fewest nasal procedures to achieve the result you desire.


Toronto Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Fillers and secondary rhinoplasty

+1

You are asking a complicated question becuase filling the nose or touching up irregularities is one thing, but camouflaging or augmenting the nose with fillers and then considering a rhinoplasty revison is another.  If you are considering a revison rhinoplasty I would not put any filler in.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

Tissue filler after rhinoplasty?

+1

You can have your nasal implant removed and then proceed to a temporary tissue filler. You can also then have another nasal implant placed. What you shouldn't do is have these procedures one after the other. In stead, to be safe, there must be time to allow your nose to recover from each procedure. Surgeons will be uncomfortable in proceeding earlier than several months and more likely a year between them. Plus your skin coverage must be health or the next step shouldn't occur

Oakley Smith, MD
Toronto Facial Plastic Surgeon
5.0 out of 5 stars 28 reviews

Cosmetic injectable to the nose will make rhinoplasty more difficult to perform

+1

The silicone implant can definitely be removed and resized to a smaller, more aesthetically pleasing implant. It is not a good idea to have Juvederm or Radiesse injections into the nose, which will make any further rhinoplasty much more difficult to perform. There are many different sizes and shapes of the silicone implants to make the Asian nose look very refined and pleasing.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

Rhinoplasty Revisions with filler injections

+1

In general, I would advise against filler injections in your case. If you decide to use a filler, hyaluronic acid is the safest, but the amount of correction is limited. It is important that your surgeon is comfortable with morphing, which I believe is an essential tool in revision rhinoplasty. That being said, I recommend removing the silicone implant and replacing it with a diced cartilage graft. This is a new technique that allows for better shaping of the nasal dorsum.

Daniel Reichner, MD
Newport Beach Plastic Surgeon
4.5 out of 5 stars 9 reviews

Fillers, Juvederm can reduce need for revision rhinoplasty

+1

nose_obsession,

Fillers such as Juvederm and longer acting Radiesse have been helpful in softening small imperfections in the nose, both in the tip and the bridge of the nose after rhinoplasty. They can help with the decision as to whether a revision is worth the effort as patients can see the anticipated result. The result of course is temporary as it lasts only as long as the fill material. The fill should not affect revision rhinoplasty, especially if you wait until all the material has resorbed.

I feel the key concern in your question is the unhappiness with the curent result and the fact that you are not sure what you would like your result to look like, the best look for your nose.

Before your make any changes I suggest you try computer simulation to test out the look of your nose. The bridge can be raised and lowered, the tip refined, all in a dry run to see if the changes possible for your nose will indeed please you. Also look carefully at pictures and faces and see if you can pin down what you like or find attractive. It could be a simpler process to change or shape the current implant to better fit your nose than to remove it altogether and start at a later date. You could use fill material in the interim, but why not consider reducing and softening the implant.

Be careful and take your time. I hope you discover what is best for you.

Best of luck,

peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 31 reviews

Any change in the tissue will make the surgery more difficult.

+1

Any modification to the tissue on the nose will make surgery more difficult. In rhinoplasty, most of the surgery is changing the underlying structure and re-draping of the overlying skin. If you have changed the character of the skin, then it makes the surgery more difficult and may effect the results. Good luck.

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 57 reviews

FIllers on nose not a good choice

+1

The fillers that you mention will be gone in 12-18 months and will not affect a rhinoplasty later. However, I think you will be wasting money in that Asian noses usually require a great deal more augmentation than can be achieved with fillers. Cartilage and soft tissue grafts will give you the result you want without wasting the money on fillers.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

Radiesse on nose can make Rhinoplasty difficult

+1

Dear Nose Obsession,

This is a great question that we get in our practice a fair bit and that we have looked into. In fact, we in association with our colleagues reviewed the largest series of injectible rhinoplasties done by anyone to date. I don’t want to make this a long diatribe about the merits of injectible rhinoplasty and if the aesthetics make a lot of sense, except to say that you should recognize that most people getting rhinoplasty want their nose at least slightly smaller whereas injectible nose jobs are by definition an augmenting procedure where the nose is made larger.

Getting injections done now can lead to distortion of what your nose really looks like and make it harder for your surgeon to know what your nose looks like originally, especially since you have already had some previous work done. While it is true that injections can be temporary if done with restylane or juvederm, they can cause scarring or inflammation or infection that can create further problems.

Moreover, other more longer lasting injectibles such as Radiesse, Sculptra, Artefill, etc can and do stay longer in the nose causing further inflammation and needing to be removed at the time of surgery. As an example, we encountered a patient who had had injectable nose job done some 7-8 months before Rhinoplasty. In him, we could still see the injectible material that had to be removed. He is now very happy with his nose and he did great, but it made surgery more difficult than it otherwise needed to be.

Peyman Solieman, MD
Beverly Hills Facial Plastic Surgeon
3.0 out of 5 stars 3 reviews

Consider more permanent nasal implant

+1

Hi!

I am not certain the filler option will provide the best look for dorsal under projection. Indeed, all are temporary in a relative sense, and further procedures may be necessary.

Consider perhaps placement of a graft, bone, cartilage as a more permanent solution. This can be undertaken using your own tissue, without adding significant downtime or scarring to the process.

Either way, in consideration of the fillers, they should not ultimately alter the nasal anatomy and preclude further procedures but ideally would be on their way to resorption prior to entertaining further intervention.

Michael A. Marschall, MD
Chicago Plastic Surgeon
4.5 out of 5 stars 4 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.