Why is my nose filler not going?

Hyaluronic acid filler remains as a semi-solid gel in discrete pockets with the subcutaneous layer of the nasal skin envelope. In simple terms, this means the filler does not occupy a continuous space, but rather multiple spaces. To effectively dissolve all the injected filler with hyaluronidase, these pockets need to be precisely injected. If you have filler remaining, then the hyaluronidase injection did not come into contact with these areas and needs to be injected more precisely as hyaluronidase is very effective at breaking down any filler it comes into contact with.

Whenever filler is added to the nose, there is a possibility of achieving a wider and larger nasal appearance. For a more definitive answer, considering asking your question with photographs. Thank you. Sincerely, Dr. Joseph

I'm sorry to hear about the challenges you're experiencing with your nose filler. Here are some insights and advice that might help you understand and address the situation:

### Potential Reasons for Persistent Filler and Migration

1. **Type of Filler Used**: Some fillers are more prone to migration than others. Hyaluronic acid fillers are commonly used for nose augmentation, but if a different type was used, it might behave differently.

2. **Technique and Placement**: The technique and precise placement of the filler are crucial. If the filler was not placed correctly, it could migrate to unintended areas.

3. **Body's Response**: Individual variations in how your body reacts to the filler can play a role. Some people's bodies break down fillers more slowly or react in ways that lead to migration or lumpiness.

4. **Scar Tissue or Fibrosis**: Repeated filler injections can lead to scar tissue or fibrosis, which might make it harder to dissolve the filler completely and might also contribute to the feeling of increased size or width.

### Addressing the Issue

1. **Consultation with an Experienced Practitioner**: It's essential to consult with a highly experienced and qualified practitioner, preferably one who specializes in non-surgical rhinoplasty or facial aesthetics. They can assess your specific situation and recommend the best course of action.

2. **Additional Dissolving Sessions**: If there is still residual filler, another session with hyaluronidase (the enzyme used to dissolve hyaluronic acid fillers) might be necessary. Sometimes, multiple sessions are required to fully dissolve the filler, especially if there is a significant amount of scar tissue or fibrosis.

3. **Management of Fibrosis**: If scar tissue or fibrosis is a concern, your practitioner might suggest treatments to address this issue, such as steroid injections or other therapies that can help reduce fibrosis.

4. **Alternative Approaches**: In some cases, patients may benefit from alternative approaches, such as surgical correction, if non-surgical methods are not providing satisfactory results.

### Why It Might Feel Bigger or Wider

- **Swelling and Inflammation**: Repeated injections and treatments can cause localized swelling and inflammation, which might make the area feel larger.
- **Scar Tissue**: As mentioned, scar tissue can create a sense of bulkiness or firmness in the treated area.
- **Filler Migration**: If the filler has migrated to the sides, it can create an appearance of increased width.

### Next Steps

1. **Schedule a Detailed Consultation**: Book a consultation with a specialist to discuss your concerns and get a thorough examination.
2. **Discuss All Options**: Explore all potential options, including further dissolving sessions, scar management, and possibly surgical solutions.
3. **Consider a Second Opinion**: If you are not satisfied with the advice or results from your current practitioner, seeking a second opinion from another expert can provide additional insights and options.

It's important to address this with a professional who can provide personalized advice based on a thorough examination and understanding of your medical history and previous treatments.

I hope this helps, and I wish you the best in resolving this issue.