A liquid rhinoplasty is a non-surgical procedure using filler agents to change the shape of the nose. When you use the words nose job or rhinoplasty, it commonly refers to a surgical procedure where the shape and function of the nose is changed. The most common changes usually are taking down the dorsal hump, increasing the rotation or elevation of the tip, and increasing the definition of the tip. These are all modifications that can be made in the operating room in a typical rhinoplasty surgery.
As filler agents have increased in popularity, the demand for non-surgical procedures has also risen. “The data showcases a remarkable 14% increase in total aesthetic procedures, largely attributed to the soaring popularity of nonsurgical procedures, which witnessed a 23% jump last year….” (source). This increased demand for non-surgical procedures has spilled over into the rhinoplasty arena and created a new procedure called the liquid rhinoplasty. In a liquid rhinoplasty, a filler agent is injected into the nose to temporarily change the shape of the nose to achieve a more aesthetic result. The most common filler agents injected into the nose are Restylane™ (Galderma) and Juvederm™ (Allergan).
What happens in a liquid rhinoplasty?
In a liquid rhinoplasty, the patient is first anesthetized or numbed up. This can be done with a topical numbing agent like BLT cream or using local blocks. Once the patient is adequately numb, the injectable agent can be injected into the nose. The following pics explain what happens in a liquid rhinoplasty procedure.
Image 1. The patient shown in this example has a small dorsal hump. In a liquid rhinoplasty procedure, Restylane or Juvederm would be injected in the area marked by the blue arrow. This would fill in the depression and mask the dorsal hump.
Image 2. This is a computer-aided model of what this patient would look like with filler added to the nose (AKA liquid rhinoplasty).
Image 3. This patient actually underwent a rhinoplasty procedure, and here is the side by side before and after surgical rhinoplasty result. You can see that the surgical rhinoplasty is softer, more feminine, and more balanced.
Why would someone do a liquid rhinoplasty?
Liquid rhinoplasty does offer some advantages when you compare it against a surgical rhinoplasty. The first issue that has to be discussed is the cost. The cost for a liquid rhinoplasty is about $700-900 and the cost of a surgical rhinoplasty is about $9500 including surgery, anesthesia and facility fees. There is no argument that a liquid rhinoplasty is cheaper.
Another item that patients may consider is the down time. A liquid rhinoplasty has a down time of about 24-48 hours. Most patients assume that the downtime of a surgical rhinoplasty is significantly greater. This is not really true. With some of the advanced dorsal preservation rhinoplasty techniques that I use, most of my rhinoplasty patients can wear makeup and return to work within 5 days.
A surgical rhinoplasty definitely has the advantage of permanence. Liquid rhinoplasty procedures are temporary and usually last about 12-14 months, whereas you can have surgery once and enjoy your new nose forever.
Why do I recommend against a liquid rhinoplasty?
I personally do not recommend liquid rhinoplasty procedures in MOST situations. There are several reasons for this. The most important reason for this is the risk of blindness. The nose is a very vascular structure. Many of the arteries and veins that feed the nose lead directly back to the retinal artery that feeds the retina of the eye. There have been several reports of filler agents injected into the nose, a small embolus of filler gets into a blood vessel, that embolus travels to the back of the eye and stops the blood flow to the retina. The result of this is blindness.
Another reason I do not like liquid rhinoplasty also deals with vascular complications. A small bolus of filler can also get trapped within a small vessel that feeds the nose and can cause necrosis of the tip skin and cartilage structures.
Images of skin necrosis after filler injections to the nose. From: SYMPTOMS AND TREATMENT OF NECROSIS OF THE NOSE AFTER FILLER INJECTION by Dong Hak Jung, MD, PhD, FKCCS, Khanh Ngoc Thi Tran, MBBS, FRACS, Haiying Li and Sang-Min Hyun, MD, PhD, FKCCS
Finally, I feel that the nose is a privileged space. The tissues of the nose really do not like foreign materials. I, myself, have changed my practice philosophy in rhinoplasty surgery to minimize implants and foreign materials, because I see significant scarring of tissues when foreign implants, etc. are used in the nose.
It is for these reasons that I recommend surgical rhinoplasty over liquid rhinoplasty.
Can liquid rhinoplasty be done safely?
Liquid rhinoplasty can be performed safely. To minimize risk of complications.
- Only go to a surgeon for nasal filler. This is an important injection with some very important anatomy. Insist on a facial plastic surgeon, plastic surgeon or oculoplastic surgeon.
- If I am going to inject the nose, I always have Wydase (hyaluronidase) on hand. This is a chemical that breaks down hyaluronic acid. It is for this reason that NO other type of filler should be used in the nose
- To inject the nose safely, canulae (blunt tipped needles) are used to minimize puncturing a blood vessel and an insert/aspirate/inject technique is used to minimize injecting filler material into a blood vessel.
Final Thoughts
My recommendation for anyone wanting to change the shape of their nose is to do a rhinoplasty. I feel that the surgical procedure is safer, more reliable, and is permanent. Furthermore, the results of a surgical rhinoplasty are softer, and more natural. I feel that liquid rhinoplasty procedures camouflages issues with the aesthetic appearance of the nose rather than fix these issues. Finally, most rhinoplasty procedures also have some degree of a functional component that needs to be addressed so that patients can breathe well after surgery. This also cannot be addressed in a liquid rhinoplasty.
- To learn more about rhinoplasty surgery, my techniques, and my philosophies check out this page: https://www.athrefacialplastics.com/facial-surgery/rhinoplasty/
- Before and after pics of some awesome rhinoplasty results (Bragging just a bit 😉): https://www.athrefacialplastics.com/gallery/facial-plastic-surgery/rhinoplasty/
- Youtube lectures and real rhinoplasty surgeries: https://www.youtube.com/channel/UCMF1Ma3CfImt3zxBqVUT6hg
Written by: Raghu S. Athré, MD FACS | 22 Jan 2024
Raghu Athré, MD FACS is a double board certified facial plastic surgeon practicing in Houston Texas. He specializes in rhinoplasty and revision rhinoplasty surgery. His secondary practice emphasis is in facial rejuvenation surgery.
