Divots around nose when I smile. How can I correct this? (Photo)

Question

I hope someone can point me into the right direction. I received a rhinoplasty in 2021 and tear trough filler. Since then I’ve noticed a bulge and divot under my eye/sides of nose when I smile. Is this from aging or a poor treatment? How can I correct this?

Nelson Lee Novick, MD · Answer

I have seen this kind of issue in patients who have come to me that have been treated with Undet-Under-Eye puffy Pillows have been relatively recently described result from the use of an inappropriate choice of filler for the infraorbital region and/or too superficial injection of the filler that has led to persistent edema and lymphatic obstruction.. In most cases the "pillows" are seen at rest, as well, but on occasion, they are subtle enough to only become apparent with broad smiling, as may be the case here. If this is indeed the case, then I have had gratifying improvement in reducing the puffiness employing varying combinations, concentrations and amounts of intralesional antiinflammatory agents. You would be wise to consult with an experienced, board certified cosmetic dermatologist filler filler expert and best of luck.

Anna Chacon, MD, FAAD · Answer

The appearance of divots or bulges around the nose and under the eyes when smiling could be attributed to several factors, including changes from your previous rhinoplasty, the effects of tear trough fillers, or natural aging processes. Here are some potential causes and solutions to consider:

Filler Migration or Volume Irregularities: Tear trough fillers can sometimes migrate or create uneven volume distributions, leading to bulges or divots. If this is the case, a follow-up with your injector could help. They may recommend dissolving the filler with hyaluronidase if hyaluronic acid fillers were used, or adding additional filler to even out the area.

Post-Surgical Changes: Rhinoplasty can alter the anatomy of the nose and surrounding areas. Scar tissue or changes in the underlying structures might contribute to the appearance of divots. Consulting with your rhinoplasty surgeon can provide insights into whether surgical revisions might be necessary.

Natural Aging: Loss of skin elasticity and fat redistribution can cause changes in facial contours. Non-surgical options such as additional fillers, laser treatments, or skin tightening procedures might help.

Consultation with a Specialist: A detailed evaluation by a dermatologist or a plastic surgeon who specializes in facial aesthetics can provide a personalized assessment and recommend appropriate treatment options.

Next Steps:

Schedule a Consultation: Meet with a qualified cosmetic dermatologist or plastic surgeon to assess the area and discuss your concerns.
Explore Treatment Options: Based on the evaluation, consider treatments such as filler adjustments, laser therapy, or surgical revision if necessary.
Maintain a Skincare Routine: Supporting your skin health with a good skincare regimen can also help improve overall skin appearance and elasticity.
Seeking professional advice will ensure you receive the most appropriate and effective treatment for your specific situation.

Shaden Mohammad, MD · Answer

Based on the photo, findings may relate to the underlying filler. Ideally, if you can find a nearby clinic that uses Ultrasound, they can identify the filler and do a targeted dissolve to give you a smoother transition. All my best, Dr. Shaden, Woodland Hills,CA.

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