Filler removal, build bridge, and reshape nostrils? (Photos)

Hello and thank you for your question.

I am not too concerned about the filler especially if you had it placed 8 years ago, and you have not had any infection issues up to this point. In terms of surgery, with the caveat that an exam in person is ideal, from your photographs alone it appears that you can benefit from a rhinoplasty where two major areas are addressed.

(1) The dorsum, aka the bridge of your nose -- if you have indeed placed filler, I would remove the filler during your surgery and augment the dorsum with mastoid fascia and diced cartilage.

(2) The tip -- it appears that you have a slightly bulbous and over-rotated tip. The significant maneuver to improve the tip is de-rotation of the tip. I perform this maneuver with extended spreader grafts, extended alar contour grafts, and a columellar strut. Oftentimes, in patients with small noses, the cartilage in your septum may not be enough to fashion these cartilage grafts, and so you will likely require MTF (Musculoskeletal Transplant Foundation) aka cadaver cartilage to perform this rhinoplasty. These maneuvers would also help address the bulbous tip -- in addition, further modification of your nasal cartilage would be done with trimming, stitching or grafting, to further refine the tip. Also note that if your septum is deviated and you have breathing difficulty, a septoplasty may benefit you as well.

The next step for you is to find the right aesthetic plastic surgeon. In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course. Also, be sure to see plenty of before-and-after pictures in women who have a similar nose appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.

After seeking out a board-certified plastic surgeon who specializes in aesthetic plastic surgery, I think the most important component of the consultation is to establish a good connection with your plastic surgeon. It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on rhinoplasty, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

Hi,
If you had hyaluronic acid filler, most of it has likely dissolved. If you had some other, more permanent substance injected then its slightly different scenario dependent on what exactly was injected. The fact that you had zero issues since 2016 is favorable. I would suggest scheduling a consultation with a plastic surgeon focused on rhinoplasty so that you can be assessed and to discuss the options.