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

Question

I had my bridge filled in the Philippines in 2016. I'm worried about the filler breaking down and getting an infection. It bothers me now and I'm worried that if I don't act now, I will have problems with it soon. Should I have the filler removed, bridge built up with a rhinoplasty, and then reshape the nostrils?

Donald Groves, MD · Answer

Hello and thank you for your question and the pictures. You actually have a difficult problem. To properly address your nose and improve your facial balance, you would need an open septorhinoplasty with lengthening of your nose to improve the overall harmony of your different facial features- I would need to place multiple grafts to address both the length and projection of your nose. This would also allow for any other potential refinements to the size, shape, and definition of your nose (especially the tip). During the surgery, I could also remove any residual filler I see.

This truly a surgery of millimeters- and whether you're looking for a minor adjustment or a major transformation, it requires exceptional surgical skill to achieve natural-looking results! Because your nose is the DEFINING feature of your face- I would only recommend seeing a surgeon who specializes in rhinoplasty procedures, and who has significant training and experience performing these surgeries. I actually trained under one of the world leading rhinoplasty experts (who performs 1,000+ nosejobs annually).

I recommend for you to setup a formal consultation with me (or another plastic surgeon who is extremely comfortable with rhinoplasties) to thoroughly discuss your surgical goals, undergo a formal examination, evaluate your options, and develop a personalized plan just for you. I hope this helps!

Dr. Donald Groves
Aesthetic Plastic Surgeon

Gianfranco Frojo, MD · Answer

If hyaluronic acid filler was injected, I recommend injecting hyaluronidase to dissolve the filler. I would wait at least 3 months and then re-evaluate before proceeding with a surgical rhinoplasty.  I would recommend finding an American Board of Plastic Surgery certified Plastic Surgeon with experience in rhinoplasty.

Ajaya Kashyap, MD · Answer

Thank you for your query. You have not specified the kind of filler you had but it appears to be some kind of a “permanent” filler. Although late complications can occur even after eight years or more, they are unlikely. However, if you wish to further improve the contours of your nose, a cartilage graft will be the way to build up your bridge. The residual filler can be removed at the same time and your nostrils can be reshaped as well. Please find an experienced board certified Plastic surgeon who can examine you and help you with all your concerns. All the best!

Eric M. Joseph, MD · Answer

Infections or problems related to injectable fillers tend to manifest themselves sooner rather than later. I am not aware of injectable fillers becoming infected so long after a treatment. If you are dissatisfied with the appearance of your nose and wish to undergo a rhinoplasty surgery to address multiple concerns, at that point, your surgeon may decide to dissolve any remaining filler, though that may be completely unnecessary at this point. I hope this helps! Sincerely, Dr Joseph

Mark K. Markarian, MD, MSPH, FACS · Answer

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

Zeshaan Maan, MD · Answer

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.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you may benefit from a tip refining rhinoplasty. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Cartilage grafts may also be used to help improve tip refinement. Nasal tip derotation with extended photographs may also help derotate your tip and a diced cartilage wrapped in fascia graft would work well as a dorsal onlay graft. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Zoran Potparic, MD · Answer

In your case an augmentation rhinoplasty using rib cartilage grafts to elongate the nose, lift the dorsum, 
shape and support the tip would be appropriate solution. Only on the basis of in person consultation one could decide whether old soft tissue fillers would be an issue in this process. Good luck.

William Portuese, MD · Answer

Much more information is needed, such as what type of filler you had placed in the nose. Was it a permanent filler, or a temporary filler.? If it was an HA product, you can have that reversed. A closed rhinoplasty approach can accomplish building up the bridge line, narrowing your nasal bones, but only give you minimal refinement of the nasal tip. Thick skin and the tip of nose is going to prevent refinement in your nasal tip.  An Alar plasty can accomplish narrowing your nostrils.

Mats Hagstrom, MD (license on probation) · Answer

If you had filler done in the Philippines, then it would be very important for us to have a good understanding of exactly what product was used. Paragraph it’s not uncommon for plastic surgeons in Asia to use silicon implants for nasal augmentation.
Are you sure you don’t have any nasal implant?
 Your rhinoplasty is going to be fairly complex and you really need to find a rhinoplasty expert for this kind of work.
Rhinoplasty surgery is complex and your case is especially complex.
Find the right provider to help you you may need to consult with quite a few plastic surgeons Before you find the right provider.
Look for plastic surgeons were members of the rhinoplasty Society.
See if you can find out the exact product that was used in the Philippines.
The most Important variable is always provider selection.
Best,
Mats Hagstrom MD

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

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