Dip in Nose After Rhinoplasty. What's a Permanent Solution?

Question

3 months after surgery, all swelling gone & has been for a month. When swelling went away, a dip showed in my nose. Dip size is not changing. Went to DR today, he suggested Radiesse, I asked if this was permanent, he said, "After 4 years with a few touch ups, we'll see, it should stimulate collagen production." But I've never heard of it as a permanent solution. I want PERMANENT. Should I let him inject? Or should I ask for a permanent surgical solution at the 6-12 month mark?

Rod J. Rohrich, MD · Answer

In general, having a significant nasal dorsal depression after rhinoplasty is not normal. However, if it persists up to 6-9 months one can do a temporary hyaluronic acid filler, which is safe on the dorsum of the nose. I would highly recommend not doing a particular long-lasting filler like Radiesse and certainly not a permanent filler as they do not do well long-term. A hyaluronic acid filler will temporize until you are about a year out and can consider doing a revision rhinoplasty to fill the supratip deformity.

David E. Kim, MD · Answer

Radiesse is made of calcium hydroxyalpatite. It is temporary. I would wait and see how it looks after several months. As the tip swelling continues to go down the dip may reduce in size.

Thomas A. Lamperti, MD · Answer

I agree that it's a bit earlier to proceed with a permanent solution to your problem. Your nose will continue to evolve over the next several months so I think waiting until then would be helpful. Although you haven't noticed any change to your nasal swelling lately, the nasal skin with shrink wrap over time.

	A filler injection with radiesse or restylane is temporary. Some surgeons use silicone off-label, but I don't have experience in this. If the problem persists a onlay graft of cartialge or other tissue could be used to permanently fill in the area.

Nick Slenkovich, MD · Answer

Wait First!

	With all due respect to my silicone-friendly colleague, I took oral board examinations for both ENT surgery and for Plastic Surgery, and I'd hazard a guess that I would have immediately failed both of these examinations on the spot if I would have suggested using silicone injections to the nose, especially just 3 months after surgery!

	First, I'd wait. 3 months is early in the healing process for rhinoplasty and too early in my opinion for judging your results or for optimally treating with fillers.

	I'd suggest waiting until at least 6 months, during which time I'd emphasize tissue massage of the nose. Then I'd consider a "temporary" filler such as Juvederm to see if you can get a result that suits you. Be sure about this and be fairly certain that a re-operation is very unlikely before considering a "semi-permanent" or permanent filler.

	Permanent means Permanent

	I have considered Radiesse (Hydroxyappetite) a "semi-permanent" filler and would consider Silicone a permanent filler.

	Silicone and other permanent fillers are definately controversial, especially in the nose. In the nose there is always going to be a higher chance of infection of any artificial material because of it's proximity to the nasal cavities and the consequences of this can be catastrophic (think Michael Jackson's exposed nasal implant). Additionally, permanent or semi-permanent fillers can be very problematic for any re-operation on the nose. Add to this that as we age our tissues naturally thin-out over time, leading to the possibility that "micro-droplets" of silicone or other material would become visible as nodules below the skin.

	I don't have experience with liquid silicone injections, but the medical literature is not all supportive of this treatment, especially to the nose, as being "safe" and "perfect" with "permanent results to your problem."

	Hope this helps,

	Nick Slenkovich, MD FACS

Nima Shemirani, MD · Answer

Dear Jeff,

	Liquid silicone is a safe injectable material that is perfect for this kind of problem.  It may take 1-3 sessions as only microdroplets are injected, but if will give permanent results to your problem. 

	Best,

	Nima Shemirani

Francis R. Palmer, III, MD (retired) · Answer

Sadly, no the Radiesse is a temporary filler that will last about 1 year and it does not create collagen formation.  The dip is from an over-resection of the dorsal cartilage during your Rhinoplasty.  I'm not a fan of silicone injections except in rare cases, such as this where there's a slight post Rhinoplasty irregularity that can be filled in easilly with a silicone injection using a micro-droplet technique.

	The other solution would be a Revision Rhinoplasty to place cartilage along the nasal bridge that would fill in and hide the dip.