A nonsurgical nose job is much less invasive than traditional rhinoplasty surgery, but still carries risks and possible side effects.
The most common side effects are swelling, mild bruising, and redness, which resolves on its own within a week or two after treatment.
Too much volume, nodules, and bumps are all possible unintended outcomes. Your doctor might be able to use more filler to correct bumps, smooth the filler into the right shape with their fingers, or dissolve it with hyaluronidase.
The most worrisome risk is vascular compromise, which happens when filler is accidentally injected into a blood vessel and the blood flow is blocked.
All facial filler injections carry this risk, but it’s a more serious concern with nasal injections because the arteries that feed the retinas are located around the nose, so blocking blood flow can potentially cause blindness and tissue death.
Dr. Schoenfeld explains that “Although retinal artery occlusion is the most serious potential complication, vascular compromise leading to nasal skin necrosis [tissue death] can also occur if injections are inadvertently placed into the arterial system of the nose, when the injections are placed too superficially, or when the injections are performed overzealously and essentially strangle the soft tissue, which leads to pressure necrosis.”
Intense pain and skin discoloration after your procedure can be a sign of a blocked blood vessel and tissue death.
If you’re still at your provider’s office and had a hyaluronic acid–based filler, they can give you a shot of hyaluronidase to dissolve it as well as take other measures—heat packs, nitroglycerin, hyperbaric oxygen, and aspirin—to manage any impending complications.
If this happens to you after you’ve left your doctor’s office, go to the emergency room right away.
Prior nose surgery can increase your risk of vascular compromise, so be sure to share your history with any physician that tends to you.
Dr. Devgan sees the biggest risks with permanent silicone fillers, like Silikon 1000. “If you accidentally inject a blood vessel around the nose, you are just stuck—there’s nothing you can do to reverse it, she says. “Even though that’s an extremely rare event with an experienced injector, it’s really not worth the risk. You can also get distortion, enlargement, and disfiguration over time.”
Dr. Ali Sajjadian, a plastic surgeon in Newport Beach, California, and past president of the Rhinoplasty Society, agrees. “I honestly cannot recommend anyone place Silikon 1000 in the nose or face.” He cautions that “no matter how small the particles are, they can form clumps, which can block important arterial blood supply for the eyes and nose.”
Because of this, the standard of care for nonsurgical rhinoplasty is hyaluronic acid fillers, with many doctors arguing that the risks of permanent fillers are not worth it.
There are others, however, who insist that Silikon 1000 (which is FDA-approved for injection in the eye), can be injected safely by a highly experienced provider, using the microdroplet technique.
“There are no reported cases of migration, necrosis, tissue loss, blindness, infection, or clumping with this product, unlike with hyaluronic acid and other temporary gel fillers,” says Dr. Eric Joseph, a facial plastic surgeon in West Orange, New Jersey.
If a problem does occur, Dr. Kotler says, steroids can be administered to reduce some or all of the filler. “This treatment isn’t always totally successful, but it’s been excellent in the very few cases where it was indicated.”
If necessary, he says, silicone can also be surgically removed, though that procedure can come with its own challenges.
