Rhinoplasty, sometimes referred to as a “nose job,” can improve the shape, size and general appearance of the nose.  However, imperfections following rhinoplasty are common, which is why some surgeons have turned to injectable fillers as a means of smoothing out irregularities and asymmetries that remain after initial rhinoplasty surgery. An article appearing in the November/December issue of Aesthetic Surgery Journal, a publication of the American Society for Aesthetic Plastic Surgery (ASAPS), discusses the potential benefits and risks of soft tissue fillers as an adjunct to surgical reshaping of the nose. 

According to ASAPS statistics, rhinoplasty is among the top five surgical cosmetic procedures, with 152,434 procedures performed in 2008.  With the growing availability, variety and popularity of filler materials, it stands to reason that the potential use of these products in conjunction with nose reshaping would be explored. 
“Injectable fillers allow surgeons to correct post-surgical imperfections without the expense, anesthetic risk, or recovery downtime involved with additional surgery,” says Steven Dayan, MD, one of the ASJ article’s three authors and clinical assistant professor in the Department of Otolaryngology, University of Illinois Medical Center in Chicago. 
Hyaluronic acid (HA), calcium hydroxylapatite gel (CaHA), and liquid silicone (all used off-label) have been used to treat nasal deformities with varying degrees of success. Silicone is generally not recommended, however, because of the greater risk of severe complications such as nodules, cellulitis and ulceration.  “The use of any soft tissue filler in the nose should always be approached with caution and with thorough consideration of a patient’s individual circumstances,” says Dr. Dayan.
As with all injectable filler treatments, technique is paramount to success.  Limiting the use of fillers to the top and sides of the nose while generally avoiding the base and tip, and placing the fillers at the proper depth in the skin, are important for minimizing complications such as a bumpy appearance,  soft tissue damage, or compromising of the blood vessels in the nose.
While soft tissue fillers may be an effective treatment for certain post-surgical deformities, they are generally not recommended as a first-line option for nasal reshaping.  Neither are they recommended for patients considering revision surgery, since persistent material in the nose may complicate a future procedure.   “Fillers are no substitute for excellent surgical results,” cautions Dr. Dayan. “Rhinoplasty surgeons must continue to strive for perfection in the operating room.”
“Injecting fillers into the nose requires a high level of skill as well as a thorough understanding of nasal structures and soft tissues,” says ASAPS President Renato Saltz, MD.  “To minimize the risk of poor results or serious complications, patients should seek treatment only by a board-certified physician with relevant training and experience.”  
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The American Society for Aesthetic Plastic Surgery, is recognized as the world's leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. The Aesthetic Society is comprised of over 2,600 Plastic Surgeons; Active Members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International Active Members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.


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