Surgeon says this was a bruise? Interested in second opinion as to what happened here (Photo)

Question

Had a liquid rhino 3+ weeks ago with Voluma performed by a board-certified plastic surgeon. Injected tip and infratip only. Felt internal stinging, pressure in columnella, developed either bruise or hyperemia. Cap refill was normal, no progression go vascular occlusion. Swelling inside of nose ruptured, bled a little, then healed. Redness fading but still comes and goes, still getting small twinges inside nose. What do you think happened here? Any theories? Thanks!

Eric M. Joseph, MD · Answer

We do not advocate the use of temporary gel fillers after rhinoplasty surgery, since necrosis would be terrible. If a bit too much filler was placed, sometimes red inflammation can occur until there is a bit of dissolution. There is no way to tell if your experience could be inflammation from a partial vascular occlusion that may have healed. In our practice, for 25 years, we have been utilizing microdroplet Silikon 1000 as a permanent soft tissue filler for permanent nonsurgical nose job treatments. Since the size of a silicon 1000 molecule is smaller than a red blood cell, it is never associated with necrosis. Thank you for your question, and I hope this was helpful. Sincerely, Dr. Joseph

Falguni Patel, MD, FACOG · Answer

There may be micro-vascular occlusions. It should not still be painful or uncomfortable this long after injection. As most know, nose filler can offer temporary improvement but is not a long-term option for nose correction. The nose is very vascular and is a high-risk area. It is generally safer and more comfortable to use a less dense filler in this area, compared to Voluma. I would recommend getting it dissolved to be safe.

Anna Chacon, MD, FAAD · Answer

Thank you for your detailed question and for providing a photo for reference.

From the description of your symptoms and the timeline, it sounds like you experienced a combination of trauma and vascular irritation following your liquid rhinoplasty. Here are a few potential explanations for what might have occurred:

Bruising and Hyperemia: The internal stinging and pressure you felt could have been due to minor trauma to the blood vessels during the injection. This can cause bruising (ecchymosis) and redness (hyperemia). Bruising is common after injections and can take several weeks to resolve completely.

Vascular Irritation: The use of a filler like Voluma can sometimes cause irritation to the blood vessels, leading to redness and swelling. The fact that there was no progression to vascular occlusion is reassuring.

Localized Swelling and Rupture: The swelling inside your nose that ruptured and bled a little before healing could have been a small hematoma (a collection of blood outside of blood vessels) or a localized inflammatory response. These can cause temporary redness and discomfort.

Residual Inflammation: The persistent redness that comes and goes, along with the small twinges inside your nose, could be due to ongoing mild inflammation or nerve irritation as the tissue continues to heal.

It's encouraging that the redness is fading and that you have not experienced more serious complications like vascular occlusion. However, if the symptoms persist or worsen, it would be prudent to follow up with your plastic surgeon or seek a second opinion from another board-certified specialist.

In the meantime, ensure you are following all post-procedure care instructions provided by your surgeon, and consider using gentle cold compresses and over-the-counter anti-inflammatory medications, if recommended by your doctor, to manage any lingering discomfort.

I hope this information helps and wish you a smooth and speedy recovery.

Surgeon says this was a bruise? Interested in second opinion as to what happened here (Photo)

Answers (3)

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.

Surgeon says this was a bruise? Interested in second opinion as to what happened here (Photo)

Answers (3)

Browse related questions

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.