Liquid or nonsurgical rhinoplasty is getting a tremendous deal of attention in the media and on Instagram, with advocates citing substantial benefits minus the risk, cost, and downtime seen with surgical rhinoplasty. However, critics are calling attention to the limited application and potentially disappointing results. Here, Washington, DC facial plastic surgeon and American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) spokesperson Michael Somenek, MD and New York City plastic surgeon Mark H. Schwartz, MD face off on the pros and cons of this increasingly popular procedure. Where do you stand?

Nonsurgical Rhinoplasty: Suitable for Certain Defects, Minimally Invasive

By Michael Somenek, MD, FACS

Nonsurgical rhinoplasty can be an effective technique for addressing certain nasal defects. The procedure is performed in the office and uses dermal fillers to transform the nose and resolve unwanted bumps, nasal asymmetries, and droopy tips.

While surgical rhinoplasty remains the gold standard for definitively shaping the nose, nonsurgical rhinoplasty has its benefits. Some people have small defects on their nose, such as a minor dorsal hump or subtle tip asymmetries, that they don't necessarily want to address surgically. Similarly, some desire improvements complementary to a previous surgical procedure and want to achieve these without the recovery associated with a revision surgery.

The procedure is attractive compared to the surgical alternative mainly because it is less costly, minimally invasive, and doesn't have the risk and recovery of a standard rhinoplasty procedure.

The dermal filler that is routinely used to perform a nonsurgical rhinoplasty is composed of hyaluronic acid. The benefit of using hyaluronic acid is that it is reversible and can be dissolved, which can be helpful if there is a vascular complication that needs to be treated. Others have used products containing calcium hydroxylapatite and polymethyl methacrylate (PMMA). This can be problematic if a patient decides that they want a surgical rhinoplasty at a later time. If a product is either permanent or longer lasting, it can potentially complicate the surgical procedure, compromise results, and increase the incidence of infection postoperatively.

Certain aesthetic improvements to the nose are not appropriate to treat with a nonsurgical rhinoplasty. These include someone looking for a narrower appearance to their nostrils, nasal tip, or who have large humps and significant asymmetries. These are areas on the nose that require surgically reshaping the cartilage, narrowing the nasal bones, or excising nostril tissue.

The nonsurgical rhinoplasty has frequently been placed in the category of a standard injectable treatment. However, understanding the nasal anatomy, including the vasculature, is of the utmost importance before performing this procedure. There are risks involved, including the potential for vascular compromise and necrosis of the nasal skin, that can cause long lasting and often permanent deformities. It is always best to seek a board-certified rhinoplasty specialist and discuss the risks of the procedure prior to undergoing this treatment.

Nonsurgical Rhinoplasty: Limited Applications, Unrealistic Expectations

By Mark H. Schwartz, MD, FACS

Non-surgical or “liquid” rhinoplasties promise a smoother profile instantly with no downtime, which can be very appealing to some patients. There is no doubt that this technique is growing in popularity and is considered by some to be an alternative to surgical correction of the nasal dorsum and tip.

However, I have seen many patients who read about this procedure in the media or see it done on Instagram and their expectations can be very unrealistic. If it sounds too good to be true, sometimes it is. They often assume that their entire nose can be reshaped without removing or replacing structural components, which, of course, can lead to disappointment and misunderstandings.

There are many aspects of the nose that a non-surgical treatment is unable to address. For instance, we can't correct a deviated septum or a severely twisted nose sufficiently with injectable fillers. In some cases, the size, or the entire nose, or a specific feature needs to be reduced for better alignment and facial harmony, and a filler can't do that, either. Sometimes what is really needed is a reduction in projection and tip size, and the camouflage effect of the filler is often not effective for this.

Having said that, temporary fillers may yield an acceptable cosmetic improvement for some individuals with minor defects, who have reasonable concerns and want to avoid surgery. It can also be a reasonable choice to correct a post-surgical imperfection. However, when done too aggressively, filler injections may also cause unwanted complications, such as bruising, infection, and inflammation. Juvéderm or Restylane are my fillers of choice for the nose, since I have an “antidote” if the patient doesn't like the results. Ultimately, some of these patients may desire a more permanent solution and request surgery.