Hi Considerate5161,Non-surgical (liquid) rhinoplasty has limitations compared to surgical rhinoplasty. The filler can mimic the shape of cartilage grafts or implants which are often used in rhinoplasty surgery. The early shape of the non-surgical rhinoplasties are very impressive and shown frequently on Instagram. However, filler is a gel and may not hold the same shape over time. I think your observation is correct that the filler may have shifted to the sides. Looking at the photos the “highlight” on the bridge of your nose is sharper on the one week photo, but less defined on the two week photos. The other observation is the width of the bridge of the nose and the tip looks narrower on the 1 week photo and wider on the 2 week photo. The filler was injected in the shape that you and the surgeon liked initially; however, the gel is not firm enough compared to cartilage or an implant which is solid shape, so over time the mound of gel flattens out, and becomes less tall and more wide.For patients asking to have the bridge of their nose raised, I tell them that there is a limitation to how high I can raise the bridge, and if I try make it higher, the gel may not stay in the middle and may shift to the side to form a wider bridge. If they ask for more, I instruct them to pinch the bridge if they feel the bridge is widening, and it will narrow the bridge while making the bridge higher. I have patients who come in 6-12 months later who feel their bridge is not as high as it was after the initial injections, and want more filler. When I take their after photos and compare to their before and immediate after photos, I noticed the bridge also became wider. For these patients, I will mold the filler by pinching the bridge to make it higher while simultaneously narrowing the bridge. I show them how to do it, so they can maintain the look. More often than not, they may not get more filler on that 6-12 month visit.I suspect that many patients are told that the filler only last 6-12 months and don’t notice the bridge getting wider, so they get even more filler to make it higher, but bridge is just getting wider. The effect of the fillers may be 6-12 months, but I think the filler lasts much longer.To reduce the chance of shifting filler, I use firmer fillers such as Restylane Defyne, Lyft or Voluma. I don’t like to use Radiesse which is also very firm, because I like to option to be able to dissolve the filler if anything unforeseen happens, or the patient wants to reverse the procedure for whatever reason. One reason is that they do like the look of the filler, but would like to switch to a surgical rhinoplasty, then the filler can be dissolved and they can still have surgery without any scar tissue leftover from the Radiesse.As a warning for RealSelf readers, I don’t like the idea of using silicone injections for non-surgical rhinoplasty either. It may look good initially, but over time the same thing can happen with all “liquid” rhinoplasties, where the filler shifts. The Pro’s of the procedure is that it is non-surgical and can be performed instantly with a needle, and it the silicone lasts forever (not necessarily the result, just the material.) The Con’s is if it shifts the silicone becomes scar tissue mixed with the silicone oil and cannot be molded with massage the same as the Hyaluronic acid gel fillers. Also, it cannot be dissolve or reversed (the material is stuck there and would need to be surgically excised.Rhinoplasty is already a highly difficult procedure, the last thing the surgeon will want to do is to remove silicone at the same time as the rhinoplasty. Some surgeons may delay the surgery if they think the blood supply to the nasal skin is compromise while trying to excise the silicone/scar tissue, to make sure the skin survives. Sorry about getting side tracked on the silicone, but is seemed to be a good opportunity to give the silicone warning. If you cannot shape the filler back to the one week shape or it keeps shifting back to the wider appearance, you can always have the filler dissolved and leave your nose alone or try a firmer filler. It may still shift, but perhaps you will not need to manipulate it as often.Good luck on you non-surgical rhinoplasty journey.Best,Dr. YangP.S. If you find my answers or other doctors answers to questions are helpful, please +1 those answers to push up the better answers to the top, which helps others who read the same post, get to the more helpful answers first.
