Nose filler after 4 years - can this be dissolved or could it be scar tissue? (Photos)

In the second and third before-and-afters you posted, are the recent images on the right? Your nose does indeed look longer in those photos, but it doesn't at all look as though the length is because of some filler: it looks as though that's just where the cartilages want to sit right now. It's vanishingly unlikely, even if there *is* some filler somewhere, that the tip of the nose would elevate if the filler disappeared.

I'm curious why you had the filler in the first place. I almost never recommend filler in the nose. When you put something *in*, the nose has to look *bigger*: wider, or longer, or bigger from the profile view. You can't add to a nose and have it look as though you took something away.

If the length bothers you, then it would be a rhinoplasty that would elevate the tip, and lower the bump. You have to be careful in selecting your surgeon. Elevating the tip of your nose adequately is not something that most rhinoplasty surgeons would be able to accomplish with expertise.

Hi! Dr. Peterson here —
Filler in the nose often lasts much longer than in other areas. Even though most hyaluronic acid fillers are marketed as dissolving within a year, in reality they can persist for years, especially in places like the nose where there’s little movement. What you’re seeing now could be residual filler, but sometimes there’s also a bit of scar tissue that forms around it, which can make the tip look more bulky.
Yes, hyaluronidase can still be used, even years later. It breaks down remaining filler, although if some of what you’re noticing is scar tissue, that part won’t dissolve with enzyme. A careful evaluation with a board-certified dermatologist or dermatologic surgeon is the best next step, since dissolving filler in the nose needs precision for both safety and aesthetics.
You definitely have options, but I’d recommend having it checked in person so your doctor can determine whether you’re dealing with filler, scar tissue, or both, and guide you to the safest approach.

Similar to what you are reporting, we have found that temporary fillers may often lead to permanent results. If there is visible and palpable filler in your nasal tip area, consider Consulting with a reputable physician to have it dissolved. We have seen HA in the nose disappear 48 hours after injecting hyaluronidase. I hope this helps, and I wish you well moving forward. Since the only Dr Joseph

Treatment depends upon what filler was used.
If a robust HA filler was used, intralesional hyaluronidase to dissolve it would be a wise start.
If a permanent filler, such as Bellafil or silicone was used, then the scar tissue below the surface engendered by the presence of these kinds of foreign substance fillers would require the use of an algorithm of varying combinations, concentrations and amounts of intralesional anti-inflammatory agents.
Semipermanent fillers, such Sculptra and Radiesse may also require the above algorithmic approach, since they, too, do not have a specific dissolving enzyme, as so the HA fillers.
The prior use of gentle subcision to break up any of the above filler masses is sometimes needed to allow for better exposure to the injected treatment materials.
Surgical removal carries the risk of leaving stretch scars and stitch tracks and, in my opinion, would be a measure of very last resort.
You would be wise to make sure to consult an experienced, board certified cosmetic dermatologist filler expert. Hope this helps and best of luck.

Thank you for your question and for providing clear comparison photos. What you’re describing—visible fullness or prominence at the tip of the nose several years after HA filler—can happen, though it is uncommon.

Possibilities to Consider:
1. Persistent Hyaluronic Acid Filler
While HA fillers (like Juvederm or Restylane) are marketed to dissolve within 12–18 months, some filler can remain for years, especially in areas with limited lymphatic drainage like the nose. The tip is also less dynamic, meaning less mechanical breakdown. This is not unusual and can sometimes resurface or migrate, making it appear larger over time.

Yes, you can still receive hyaluronidase even years later. It’s safe and effective for breaking down residual filler. A small test spot is usually recommended to assess for overcorrection or sensitivity, especially if you've never had it before.

2. Scar Tissue or Capsule Formation
It’s also possible that the area has developed fibrosis or a capsule—a dense area of scar-like tissue around the filler. This can occur even with HA fillers, especially after repeated treatments or inflammation. Scar tissue won’t dissolve with hyaluronidase, but it may soften over time or respond to steroid injections, microneedling, or RF treatments.

3. Filler Migration
Filler can subtly shift downward or become encapsulated, creating an exaggerated shape at the nasal tip. This can contribute to the longer-looking nasal profile you mentioned.

What You Can Do:
Ultrasound evaluation (if available) can distinguish between residual filler vs. scar tissue.

If it's filler: Hyaluronidase injections are still appropriate and can improve shape significantly.

If it’s scar tissue: Kenalog (steroid) injections or gentle needling may help break up fibrotic tissue.

If structure has changed permanently: A surgical consultation may eventually be needed if you're unhappy with the shape, though this is usually a last resort.

Thank you for your patience in managing this—it’s a frustrating but solvable issue with the right approach.