Non-surgical Rhinoplasty - is It Safe? Why So Controversial?

I really want non-surgical rhinoplasty, but shy away due all of the bad press surrounding the procedure. I can afford a surgical nose job, but prefer not to go under the knife. I think most people would consider me attractive, but my profile is asymmetrical, and when I smile my nose droops. It bother me immensely.

I want to get a non-surgical rhinoplasty and feel safe going into the procedure. Can someone reassure me about this controversial procedure? HELP!

Doctor Answers 19

Non-surgical rhinoplasty is not an accurate term

As someone else answered, 'non-surgical rhinoplasty' is a misnomer. A rhinoplasty, by definition, is a surgical procedure. This highlights the problem with the term, and the procedure. Let me be clear: There is no filler technique that is a substitute for nasal surgery. Just because a filler can be used in the nose does not mean that it is the best solution. The nasal soft tissues are unlike any other found in the face. There are many complications that can occur, regardless of how experienced the injector is. That being said, there are indeed many surgeons who feel that some fillers can be used conservatively AFTER a rhinoplasty for very subtle contour deformities. I have some very important advice for you: If there is ANY chance that you would consider a rhinoplasty in the future, you should steer clear of filler injections in the nose.

Fort Lauderdale Facial Plastic Surgeon
4.9 out of 5 stars 82 reviews

What's the deal with non-surgical rhinoplasty?

In this “liquid”, “non-surgical” procedure, a combination of Botox and facial fillers are injected to achieve the desired result without a scalpel. In the right candidate, a Liquid Rhinoplasty can even out irregularities along the bridge of the nose, make the nose appear straighter, raise the nasal bridge, or camouflage a dorsal hump on the profile view. Although you are technically adding volume with filler, the end result is often a nose that appears smaller and more refined. The idea is to change the way light hits your nose, creating a kind of semi-permanent contour makeup on your nose. During a liquid procedure, ice is used to numb the skin, and small needles are used to inject filler and/or Botox. Not all nose concerns are amenable to liquid, non-surgical, rhinoplasty, but if you’re among the lucky (or unlucky, depending upon how you look at it), you can skip the pain and recovery of surgery. Results are dramatic and instant, and so are the savings!  As compared with surgery, non-surgical rhinoplasty saves time, money, and pain. For most patients, there is essentially no downtime, and the major downside is that the procedure is that it’s not permanent. Depending on the filler selected, the results generally last from 1-2 years. Sounds like a good deal, no?

It is important to note, however, as we become more accepting of the idea of being poked and prodded with needles as a part of our routine beauty upkeep, that all of these injections, while effective, and amazing when done properly and subtly, are not without risk.

Vascular compromise leading to skin necrosis (actual death of skin because of decreased blood flow to the area) is the dreaded risk of non-surgical rhinoplasty. It can either occur from filler material actually getting into blood vessels, or from filler material pushing on blood vessels under the skin. While appropriate training and experience can help to minimize the risk of this occurring, the risk is never zero. Studies have shown a rate of vascular compromise after filler injection of approximately 0.05% even in the hands of highly trained physician injectors. That equates to approximately 1 in 2000 times that facial filler injections are performed in the nose. Thankfully, vascular compromise is exceedingly rare, and when treated promptly, and correctly, will resolve without long-term consequences. But that is the key- it must be attended to swiftly and expertly, and if not treated appropriately, long-term consequences can be serious.

This is the reason that you should always ALWAYS be sure that your injector is properly trained, and knows how to handle vascular compromise after filler injection, whether they have personally experienced it first hand or not. All physicians who inject hyaluronic acid fillers like Juvederm, Restylane, Perlane and Belotero, should stocking hyaluronidase in their office (this is the enzyme that breaks down the hyaluronic acid fillers used for liquid rhinoplasty). So, while non-surgical rhinoplasty can be amazing, and is often quick, easy, and effective 1,999 out of 2,000 times, it is not without risks. Choose a plastic surgeon or dermatologist who is well trained, competent, approachable, and responsive to you and your concerns. 

Dara Liotta, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 30 reviews

Safety of Nonsurgical Rhinoplasty

Nonsurgical Rhinoplasties are very safe if done properly with a well-trained surgeon.  Seeing a surgeon that understands nasal anatomy, and has experience operating on a nose, is the best way to start.  Next, find out if they use needles or a cannula to inject the filler.  Using needles for injection in the nose is what leads to problems and 'bad press'.  Cannulas are safer though experience with cannula injection is important.  

Finally, find a surgeon who offers a multitude of fillers for your nonsurgical rhinoplasty.  Every skin type is different and creating a bridge requires a different filler than filling a defect or creating symmetry.  Thin skin utilizes a different filler than thick skin so having a variety of fillers to choose from is important.

Mike Majmundar, MD
Atlanta Facial Plastic Surgeon
4.6 out of 5 stars 49 reviews

Nonsurgical Rhinoplasty

For the right patient a "nonsurgical rhinoplasty" can be a good procedure.  A nonsurgical rhinoplasty is a procedure in which a filler is added to portions of the nose to give it a more aesthetic appearance.  This is not suitable for everyone.                                                 

It can be particularly useful for someone who has already had a nasal procedure and wants to improve the results of the surgery - a type of revision rhinoplasty.  

Similar to all procedures there are some associated risks.  As for all procedures you should discuss the risks and options with your surgeon before having the procedure performed.

Currently we do not recommend using permanent fillers for this as there can be a risk of delayed complications.

Paul Carniol, MD
Summit Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Generally yes, it is safe!

Every procedure has a level of risk, and non-surgical rhinoplasty is not an acception to this rule.  Although rare, fillers can cause skin tissue necrosis, scarring and changes in the quality of the skin.

My recommendation is to see a rhinoplasty surgical specialitist who also performs non-surgical rhinoplasty to ensure you are an appropriate candidate.

Babak Azizzadeh, MD
Beverly Hills Facial Plastic Surgeon
4.1 out of 5 stars 9 reviews

Non-surgical nose job

Using fillers to adjust minor asymmetry is Ok in some instances.  However, to raise the tip significantly and to contour the tip, surgery is usually better. 

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Nonsurgical Rhinoplasty: benefits and limitations

Nonsurgical rhinoplasty can certainly be an excellent option for the right patients.  The advantages of this procedure include reduced downtime, ease of reversibility, and cost.  However, not every nose can properly be addressed through the use of fillers and Botox and the effects are often temporary.  Therefore I would urge you to seek consultation with a surgeon who is skilled at both surgical and nonsurgical rhinoplasty.  Through the use of computer imaging, you and she/he can decide upon your goals and objectives and determine the best approach.  The last thing I would add is that traditional, "surgical" rhinoplasty is an extremely safe and effective procedure with high patient satisfaction, when performed by a specialist in this type of surgery. 

Umang Mehta, MD
Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 49 reviews

Non-surgical versus Surgical Rhinoplasty

Depending on your issue, you may be a good candidate for a non surgical rhinoplasty procedure with dermal fillers.  However, the nose drooping with smiling is due to depressor muscle action which would require a surgical procedure to correct.  

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 77 reviews

Non Surgical Nose Job is controversial now because it is a new technique

Non Surgical Rhinoplasty, like fillers in general represents a tremendous advancement in facial cosmetic procedures.  An individual can have their nose shaped, ( like other areas of the face), without undergoing the trauma and injury of cutting skin, breaking bones, and waiting months to recover.

Non Surgical Nose Job (Rhinoplasty) is however a very specialized technique requiring experience with both fillers and nasal anatomy.

This particular nose could be treated with fillers place and the root of the nose to make it less curved and some Botox place under the nose to reduce the dip that occurs with smiling.

For an example of a Non Surgical Rhinoplasty, please click the link below.

David C. Mabrie, MD
Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 111 reviews

Improving the Nose with Non-Surgical Rhinoplasty

Hi jahans in Minnesota,

First, be very careful with any injections into the nose. The nose is very susceptible to color changes, discoloration, swelling, blood flow, pain, numbness, and other potential complications with inappropriate injections into the nose.

There isn't a filler on the market currently that is FDA approved for injection into the nose. Everything is being used off-label. Fillers should never be placed into the tip of the nose, since complications may more likely occur at the nasal tip. Fillers should only placed in the bridge to help smooth contour irregularities and to provide augmentation. Fillers which have been used for nonsurgical rhinoplasty include Radiesse and hyaluronic acids.

One non-surgical rhinoplasty option for you could be Botox Cosmetic. Botox may injected into the base of the nose in specific areas to help reduce the droopy tip when smiling. Results would be temporary, lasting a few months.

Depending on the specific anatomy of your nose and your desires, I suggest first speaking with a rhinoplasty surgeon who can use computer imaging to simulate rhinoplasty. You'll be able to visualize in real time what possibilities are potentially available. Only after a comprehensive in-person evaluation can a plastic surgeon help determine the appropriate options for you.

Dr. C

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 85 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.