Can Juvederm Be Safely Used for Reshaping in the Nose? What is the Safest Filler to Use in Nose?

Question

Hello, I have been doing extensive research on the non-surgical nose job. Rhinoplasty is out of the question. for what I've researched, it has a high revision rate. Anyway, I went to this doctor, in Phoenix, that said he is the only one that uses Artefill for nose reshaping. he was evasive and even got mad when I kept asking questions. He said he uses a technique from Brazil. I do not trust him! What's the safest filler to use in the nose? Thanks!

Nelson Lee Novick, MD · Answer

I have been performing nonsurgical nose jobs for more than a decade already and have found that semi-permanent volumizing fillers, i.e. those fillers designed for deeper injection and more lift and bulk work best and yield gratifying, relatively long-lasting results. In the U.S., volumizing agents include Perlane L, Juvederm Ultra Plus XC, and Radiesse (or Radiesse combined with one of the two agents), and I rely on these in my Upper East Side office. Juvederm and Restylane, simple fillers, are best reserved for treating fine lines, tear troughs, and skin crepeyness since they are intended to be injected more superficially.

	In my practice in Israel, I prefer to use even bulkier hyaluronic acid-based agents for nonsurgical rhinoplasty, such as Stylage XXL, Juvederm Voluma, or Restylane SQ (all of which unfortunately are not yet available in the U.S.). My experience is that these agents tend to require the use of less material and last considerably longer

	Although on the surface it would seem preferable to use permanent agents, such as silicone, Artefill, or Aquamid (not available in U.S.), these materials are completely foreign to the body and cannot be eliminated by it. So, if there are problems or nodule formation, these can be extremely difficult to treat. Semipermanent materials, on the other hand, can be dissolved with the enzyme hyaluronidase and even Radiesse may be broken up to hasten its removal with the repeated use of salt injections. 

	I generally remind my patients that they have no problems going to the hair dresser to dye their hair or to the dental hygienist several times per year. So, returning ever year or two for five minute nasal touch up is not such an ordeal and is preferable to being stuck with unwanted bumps, etc., in the event that something goes wrong with a permanent injectable fillers.

Sam Rizk, MD · Answer

Yes, Juvederm is a completely safe product that
is often used as a non-surgical alternative to a rhinoplasty. The temporary,
injectable filler is FDA approved in the United States and can produce
noticeable results that last up to a year. Other common fillers that are used
for non-surgical nose jobs include Restylane and Radiesse. Fillesr may
camouflage a bump but do not make the nose look smaller. They also do not
address issues such as a bulbous nose tip. As a general rule, always be sure
that any injectable filler your doctor is recommending is FDA approved before
moving forward with the procedure.

Eric M. Joseph, MD · Answer

During my fellowship in Facial Plastic Surgery, my rhinoplasty teacher taught me the art of using small amounts of Silikon-1000 for improving irregularities following Rhinoplasty Surgery.  Silikon-1000 is an off-label filler that may be used to improve the appearance of your nose provided the material is injected properly and in small amounts. You also must be a good candidate for an injectable filler treatment for your nose.

	In my practice, problems related to silicone injections in the nose are rare. You can form a nodule or bump (<1% of procedures), or rarely you can get a local area of prolonged redness (.03% of procedures). Noses that are heavily grafted from previous rhinoplasty have a tendency to be more problematic than overresected noses that welcome the added volume.

	You may want to re-post your question with photos for the RealSelf community of experts to comment on.

	I hope this is helpful for you.

	Dr. Joseph

Remus Repta, MD · Answer

Hello,

	The hyaluronic acid fillers (aka Restylane and Juvaderm) are the safest since they can be injected deep or superficial and do not form granulomas (inflammatory reaction nodules).  I would recommend them as a temporary non surgical nose shaping treatment.  Another modality is fat.  Fat will be a permanent filler, so if you like what juvaderm accomplishes for the shape of your nose you can transition to getting fat.  Below is a before and after photo link of a patient that I did fat grafting to the nose.

	All the best,

	Dr Remus Repta

Jenifer L. Henderson, MD · Answer

Occassionally I do use fillers in the nose. The safest areas to inject are along the nasal dorsum over the bone and dorsal nasal cartilages. Injecting the nasal tip can be a bit more risky and could result in compromise to the nasal skin vasculature. I would recommend only using hyaluronic acid fillers - like Juvederm or Restylane, they have a soft "gel like" substance and are reversable if needed. Thank you.

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