Safest way to reinject filler after hyperemia reaction in nose? (Photo)

Question

3 weeks ago I had a liquid rhinoppasty performed by a board-certified plastic surgeon using Juvederm Voluma. Developed pain, internal swelling of nasal lining, and either a bruise or hyperemia. Surgeon says bruise. No vascular occlusion symptoms, cap refill normal. I love the result, but wonder about safety. If I were to get refilled, should I dissolve whatever remains first to be safe? (History of rhinoplasty, btw.) What is the safest way to refill a previously injected nose?

Anna Chacon, MD, FAAD · Answer

In your case, since you experienced pain, swelling, and discoloration after the initial injection—even without overt vascular occlusion—it’s wise to proceed with caution. If reinjection is considered, the safest approach is typically:

Wait until complete resolution of swelling, redness, or bruising before any further filler work. This allows tissues to heal and reduces the risk of compounding inflammation or injury.

Assess the underlying tissue health via a thorough in-person examination to ensure normal vascular status and no lingering compromise.

Consider dissolving residual filler with hyaluronidase prior to reinjecting, especially if there’s uncertainty about vascular safety, product placement, or tissue integrity from the first procedure.

Use a highly cautious reinjection technique—such as microbolus or microthreading with a blunt cannula and minimal volume—while continuously checking for capillary refill and patient comfort.

Select a conservative filler plan or even reassess whether further filler is necessary, given your history of rhinoplasty and prior reaction.

This layered safety strategy helps minimize vascular risk and ensures any reinjection is performed in the healthiest possible tissue environment.

Eric M. Joseph, MD · Answer

Consider using a different one that, perhaps, is less viscous, and less likely to cause vascular occlusion. We have been performing permanent nonsurgical nose jobs with microdroplet Silikon 1000 for over 25 years, and it does not lead to necrosis in anybody, and it may be well-suited after previous rhinoplasty surgery for adding lost volume and camouflaging some of the stigmata of previous surgery in the nasal tip. Thank you. Sincerely, Dr. Joseph

Gerald Minniti, MD, FACS · Answer

Despite 'normal capillary refill' (I put in quotes because that is a very user dependent measurement) and  hyperemia, you experienced a vascular occlusion, either by direct cannulation or by space occupying compression. That would explain the pain, a very important symptom of vascular occlusion, mucosal swelling, and hyperemia, the body's attempt at getting more blood flow into an area of relative ischemia.   Fortunately, you appear to be healing without loss of skin or other tissues.

Safest way to reinject filler after hyperemia reaction in nose? (Photo)

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Everything you need to know about Nonsurgical Nose Job

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Safest way to reinject filler after hyperemia reaction in nose? (Photo)

Answers (3)

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Recommended reading

Everything you need to know about Nonsurgical Nose Job

Our mission is to create a world where every investment in modern beauty is Worth It.