Is it safe to have filler in the nose after rhinoplasty?

Question

28 Year old South Asian Male. I had a rhinoplasty 3 years ago to fix my bulbous tip. Although I'm happy I no longer have a bulbous tip, I find now my problem is that my tip is too refined and my nose from a front profile is not flush. I'm currently on the fence if I should go for a revision rhinoplasty, or if I should try filler. I've consulted multiple professionals, a nurse that does filler, a dermatologist, and even reaching out to a clinic that said they do not do filler in the nose if one has had a rhinoplasty before, and the jist I'm getting is they wouldn't even risk it due to blood vessels, necrosis etc. I've consulted an actual ENT/ Plastic surgeon that has performed rhinoplasty and non-surgical rhinoplasty and he seemed fairly confident that it can be done safely on me, especially after he viewed the sites he believed he would be injecting. As you can see I'm a little confused as to what I should do. I guess the fear would be I understand filler in the nose after a rhinoplasty is more riskier than one that hasn't had one, but it can still be done safely. But say if I get the filler done once a year for 40 odd years due to the filler dissipating, it increases my chances now of something like necrosis.

Anna Chacon, MD, FAAD · Answer

It is understandable to feel conflicted about your options after rhinoplasty, especially when considering non-surgical enhancements like filler. Filler can be used to address minor contour irregularities or asymmetries after rhinoplasty, and in experienced hands, it can be performed safely—even in patients with prior nasal surgery. However, you are correct that the risks are higher compared to an unoperated nose.

Rhinoplasty can alter the vascular anatomy of the nose, making the blood supply less predictable. This increases the risk of complications such as vascular occlusion and skin necrosis if filler is inadvertently injected into or compresses a blood vessel. For this reason, some providers avoid nasal filler in post-rhinoplasty patients, while others with advanced training and experience may offer it with careful technique, using small amounts of filler and slow, precise injections.

If you choose to proceed, it is crucial to see a board-certified dermatologist, facial plastic surgeon, or plastic surgeon with extensive experience in both rhinoplasty and non-surgical rhinoplasty. Long-term, repeated filler injections do not necessarily increase the risk of necrosis, but each procedure carries its own risk, so cumulative risk does exist. Ultimately, the safest approach is to have a thorough consultation with a highly qualified provider who can assess your anatomy and discuss the risks and benefits in detail.

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