How do I still have filler in my nose after 2.5 years?

Question

I got a nonsurgical rhinoplasty with the help of fillers in july 2020, and they still haven’t dissolved. How is this possible? My doctor used Juvederm Voluma I believe. (I want to get a nose job soon but read that I’ll have to get my filler dissolved first)

Eric M. Joseph, MD · Answer

I believe temporary gel fillers last the longest in the nose is because the nose is a static structure. It doesn't move like lips or the rest of your face. In that regard, we have seen temporary gel fillers last for years in the nose. That said, the dissolving enzyme may be considered for a rapid dissolution of hyaluronic acid. I hope this is helpful. Sincerely, Dr Joseph

Sean Arredondo, MD · Answer

One of the most important factors affecting filler duration is movement. The more an area moves the less time the filler will last. In areas with little or no movement, it can last a very long time! The decision to dissolve the filler depends on the location of the filler and the changes you are trying to achieve. In areas that require more finesse the fillers can distort the overall appearance and make results less predictable. In some cases we can use an ultrasound to help us see filler under the skin, this can help determine which areas to target when dissolving filler. My recommendation would be to speak to a surgeon regarding your goals and they will advice you if the filler should be dissolved before a surgery.

Sergio Verduzco Casillas, MD · Answer

Hello, thanks for your question. You can dissolve the remaining filler in your nose with the help of your surgeon before having a rhinoplasty. Your doctor may detect the points where the filler is and extract it before going to the surgery room. Talk to a board-certified surgeon in your area to have a physical exam. Good luck!

Inessa Fishman, MD · Answer

Fillers likely stay in the tissues for a lot longer than the few months-a year.  There are imaging studies that show presence of hyaluronic acid filler in the tear troughs on MRIs 14 years after injection.  The nose is also not a very mobile area, which likely translates into fillers sticking around for a longer as opposed to shorter period of time.  Voluma is a more cross-linked filler, meaning its hyaluronic acid subunits are more tightly connected than some other fillers; and this may need several dissolving sessions to treat.  As a surgeon who does rhinoplasty, I often find leftover filler in the nose even after it's been treated with dissolving medication; and then I just mechanically remove the filler.  Speak with your rhinoplasty surgeon about your filler history, to create a customized pre-treatment and treatment plan.  Good luck!

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