What are the risks/complications of non-surgical nose jobs?

Question

I have a very noticeable dip on the tip of my nose and essentially have two nose tips. I want to have this 'dip' filled in with a hyaluronic filler. HOWEVER, the risk of necrosis/blindness is scary, especially as the tip of the nose is apparently the most risky. I have read that the use of a blunt cannula and dilution of the filler with lidocaine and/or epinephrine can minimise complications. Im interested in the experiences of doctors here. Are the risk minimisation techniques important?

David C. Pearson, MD · Answer

From your description, your nose seems to suffer from what we call a bifid tip. Risk minimization is always important in medicine and surgery, but especially when the goal is an aesthetic one. After all, the patient was perfectly healthy to begin with! That said, the most serious risks from fillers in the nose and face such as blindness are exceedingly rare and have been well reviewed in the medical literature. And if it's any reassurance, it's the sides of the nose and the bridge of the nose that are riskier than the tip in terms of blindness.  Like most things, careful technique (e.g., aspirating before injecting, using minimal injection pressure, knowing the anatomy, etc.) can reduce the chance of a bad outcome. The most common risk is really just that of a poor aesthetic result or simply one the patient doesn't like. For that reason I tend to use a temporary filler such as Juvederm first. The hyaluronic acid fillers like Juvederm can be also reversed if needed with a simple injection of hyaluronidase. Other risks such as granulomas (hard, reddish lumps that look like pimples that won't go away) can occur but can also be managed with medication. Tip necrosis (death of the tip skin) is also very rare and can usually be avoided by following the techniques I mentioned above. Infection from fillers is very, very rare on the face. Bruising and swelling vary by patient, of course.Hope this helps,--DCPPearson Facial Plastic Surgery®

Eric M. Joseph, MD · Answer

Gel fillers like HA maybe associated with vascular occlusion, thrombosis, necrosis, embolism, stroke, blindness, and biofilm. The many reasons why we advocate microdroplet Silikon-1000 injections for permanent non-surgical nose job treatments since a Silikon-1000 molecule is smaller than a red blood cell, complications like necrosis, embolism, stroke, blindness, and biofilm simply do not happen. I would also like to mention that serious complications with temporary gel fillers are uncommon, and I believe that they are largely associated with the person who is holding the syringe. I would not advocate utilizing a cannula in the nose, since this would lead to excessive downtime and is largely unnecessary, in our opinion. I hope this helps. Sincerely, Dr Joseph

Luis A. Cenedese, MD, FACS · Answer

The FDA advises that any filler injected into the face or nose can lead to necrosis or loss of vision. This is possible even in the most experienced of hands.  Complications from hyaluronic acid fillers may be minimized with the use of hyaluronidase.
Certain areas i.e. the side of the nose and inner eyelid region pose a greater risk for serious complications. Use of a blunt cannula is a good idea but not always possible due to the fibrous nature of the nasal subcutaneous tissues.
If the risk associated with a procedure is too great for one to undergo, it should be avoided.
Please consult in person with an experienced Board Certified Plastic Surgeon prior to making treatment decisions.

Robert T. Buchanan, MD (retired) · Answer

All procedures have risks and minimizing those risks is always important. It is also important to use the correct product for the specific problem. The risk of blindness and skin loss when injecting the tip of the nose is actually less than injecting other areas of the nose as there are less large (though still small) vessels there. These risks can be reduced significantly by experience of the injector and use of a blunt canula. I never use lidocaine or epinephrine locally where I am going to be injecting as it distorts the area and the result may not be what is wanted, thus requiring a second injection. I generally use Juvederm Voluma, though I previously used Radiesse, because they are strong enough to hold the correction where other fillers aren't. Make sure you see an expert injector in this area.

What are the risks/complications of non-surgical nose jobs?

Answers (4)

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