Silicone micro-droplet for dip in the tip of my nose - that are the risks? (Photos)

Question

I had a revision rhinoplasty 4 years ago. For the first time in 30 years, I stopped noticing my nose because it really fit my face and looked normal! However; as swelling decreased 1.5 years later, I started to notice a dip in the tip of my nose which created a harsher, more irregular look. Now, I'm back to obsessing and feeling insecure. My revision doc said its an easy fix with silicon microdroplet and safter long term in that area than filler. I am really nervous to develop granulomas or nodules which I read can happen decades later. In your experience, what are the probability of risks, esp in that area? Also, are injections less risky than anther surgery?

Anna Chacon, MD, FAAD · Answer

It's understandable that you're weighing this decision carefully, especially after going through two rhinoplasties. Having finally reached a point where you were happy with your nose, only to notice a small contour change as the swelling settled, can be frustrating. Fortunately, what you're describing—a localized dip in the nasal tip several years after surgery—is a situation that can often be addressed without another operation.

Silicone microdroplet injections have been used by some experienced physicians for small contour irregularities after rhinoplasty because the material is permanent and, when placed correctly in very small amounts over multiple sessions, can provide lasting correction. Your surgeon is likely recommending it because a tiny depression sometimes requires very little volume, and repeated temporary filler treatments may not be appealing.

That said, your concerns about long-term complications are valid. Unlike hyaluronic acid fillers, silicone is not reversible once injected. Although many patients do well when the microdroplet technique is performed properly, complications such as granulomas, nodules, chronic inflammation, or migration have been reported, and these can occasionally occur years or even decades later. Fortunately, these complications are considered uncommon in experienced hands, but because they are permanent when they occur, they deserve careful consideration.

Hyaluronic acid fillers have a different risk profile. They are temporary and can be dissolved if needed, which gives both the patient and the injector more flexibility. However, the nose is a high-risk area for filler because of its blood supply. Any injectable placed in the nose—including silicone or hyaluronic acid—requires meticulous technique to minimize the risk of vascular compromise.

When comparing injections with another surgery, neither option is completely risk-free. A third rhinoplasty involves scar tissue, longer recovery, and the possibility of creating new contour irregularities. For a very small defect, surgery may be more invasive than necessary. Conversely, injections avoid another operation but introduce their own potential complications, particularly if a permanent material is used.

In a case like yours, where the concern is a small, stable contour defect, the decision often comes down to whether you are comfortable accepting the permanence of silicone. If the idea of a permanent implantable material and its rare but lifelong risks causes significant anxiety, that is an important factor to consider. Some patients prefer the predictability and reversibility of temporary fillers, even though maintenance treatments are required.

Overall, a small post-rhinoplasty depression can often be improved with a conservative approach. The most appropriate choice depends not only on the anatomy of the defect but also on your comfort level with permanent versus temporary correction. Since you've already had excellent surgical results overall, preserving that outcome while minimizing unnecessary risk is a thoughtful and reasonable goal.

Gerald Minniti, MD, FACS · Answer

Contrary to the vast array of medical and aesthetic silicone elastomer implants available that are extremely biocompatible, uncrosslinked silicone oils are inflammatory and unpredictable in their behavior, especially long term. After a long period of appearing benign they can suddenly lead to significant deformity, and in the confined space of the nose, injury. If you don't want to do the right thing, which is another revision rhinoplasty, then a hyaluronic acid gel should be injected carefully by an expert; injections of a virgin nose is always difficult and carries some risk of vascular occlusion, but injection of a post surgical nose is even riskier. Revision rhinoplasty is extremely difficult and rarely are results absolutely perfect, but if you were in my practice with the current appearance of your nose, I would qualify it as a failure that could be significantly improved, and would urge you to allow me to fix without a surgeon's fee or happily refer you to another surgeon. Honestly, I'm surprised your surgeon would recommend silicone 'micro droplet' injections given the relative safety and longevity of the results from gels.

Ronald J. Edelson, MD · Answer

The problem with silicone is that it could become infected and you would have the silicone coming through the skin. Better off with conventional fillers.

Silicone micro-droplet for dip in the tip of my nose - that are the risks? (Photos)

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