Everything You Need To Know About Liquid Rhinoplasty

At my officeanything non-surgical or “liquid” is exploding in popularity, and that includes rhinoplasty. According to data released by RealSelf today, liquid rhinoplasty was in the top 15% of most-visited minimally invasive topics on the site; compared to last year, the topic grew 50% in popularity in the latter half of 2015 (even taking into consideration site growth)—that’s a major upswing.

With the increasing popularity, there has been some debate on the efficacy of this procedure: I think it’s important for patients to realize that not everyone is a candidate. Let me explain exactly how it works, how to tell if it’s right for you, and the pros and cons of committing to a liquid rhinoplasty.

HOW IT WORKS

During a liquid procedure, ice is used to numb the skin, and small needles are used to inject filler and/or Botox. In this “liquid”, “non-surgical” procedure, Botox and facial fillers are injected to achieve the desired result without a scalpel.

THE RIGHT CANDIDATE

In the right candidate, a liquid rhinoplasty can even out irregularities along the bridge of the nose, make the nose appear straighter, raise the nasal bridge, or camouflage a dorsal hump on the profile view. Issues with the nasal dorsum or the bridge of the nose are generally better treated with liquid rhinoplasty than issues wih the nasal tip. Although you are technically adding volume with filler, the end result is often a nose that appears smaller and more refined—essentially, the nose is more balanced. This is also an ideal procedure to even out anything a patient wasn’t satisfied with in a traditional rhinoplasty. You could almost think of it as semi-permanent contour makeup on your nose.

THE PROS

Not all nose concerns are amenable to liquid (non-surgical) rhinoplasty, but if you’re among the lucky (or unlucky, depending upon how you look at it), you can skip the pain and recovery of surgery: for most patients, there is essentially no downtime—a big bonus. Results are dramatic and instant, and the savings can be too, depending on your individual case—another big bonus. In addition, the filler I use is reversible, so if you don’t like it, it can be dissolved.

THE CONS

The major drawback is that the procedure is not permanent. Depending on the filler selected, the results generally last from 1-2 years.

Also, as we become more accepting of the idea of being poked and prodded with needles as a part of our routine beauty upkeep, it’s important to remember that all of these injections, while effective, and amazing when done properly and subtly, are not without risk. Vascular compromise leading to skin necrosis (actual death of skin because of decreased blood flow to the area) is the dreaded risk of non-surgical rhinoplasty. It can either occur from filler material actually getting into blood vessels, or from filler material pushing on blood vessels under the skin. While appropriate training and experience can help to minimize the risk of this occurring, the risk is never zero. Studies have shown a rate of vascular compromise after filler injection of approximately 0.05% even in the hands of highly trained physician injectors. That equates to approximately 1 in 2000 times that facial filler injections are performed in the nose.

Thankfully, vascular compromise is exceedingly rare, and when treated promptly, and correctly, will resolve without long-term consequences. But that’s the key—it must be attended to swiftly and expertly, and if not treated appropriately, long-term consequences can be serious.

HOW MUCH DOES IT COST?

The procedure will likely cost (depending on the filler used) between $850 – $1,200.

CHOOSING A SKILLED COSMETIC SURGEON IS KEY

You should always, always be sure your injector is properly trained and knows how to handle vascular compromise after filler injection, whether they have personally experienced it first hand or not.

All physicians who inject hyaluronic acid fillers like Juvederm, RestylanePerlane and Belotero, should stock hyaluronidase in their office (this is the enzyme that breaks down the hyaluronic acid fillers used for liquid rhinoplasty). So, while non-surgical rhinoplasty can be amazing, and is often quick, easy, and effective 1,999 out of 2,000 times, it is not without risks. Choose a plastic surgeon or dermatologist who is well trained, competent, approachable, and responsive to you and your concerns.

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Dr. Dara Liotta, MD, is a plastic surgeon practicing on the Upper East Side. 
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