Liquid Rhinoplasty: How to Make Patients Aware of the Risks

The bride wanted her wedding day—and photos—to be perfect.

There was just one problem: her nose.

It was crooked. And because the big day was only a few weeks away, there wasn’t time for a surgical rhinoplasty.

“She’d always hated her nose and asked me, ‘Can you just fix my nose for the pictures?’” said Theda Kontis, MD, a Baltimore-based otolaryngologist who is board certified in both facial plastic and reconstructive surgery and otolaryngology–head and neck surgery.

The bride was the perfect candidate for liquid rhinoplasty, the injection of dermal fillers to reshape the nose. She had not had surgery on her nose previously, and she accepted and understood the risks, including possible blindness should the filler get into the blood vessels supplying the eye. Dr. Kontis, author of Cosmetic Injection Techniques, drew upon her years of experience and expertly sculpted the patient’s nose by injecting small amounts of dermal filler into strategic locations.

The bride’s nose was in perfect shape for her wedding.

Non-surgical rhinoplasty has been available for about 15 years; however, demand has increased in recent years (Plast Reconstr Surg Glob Open. 2016;4:e683). This trend may be fueled largely by social media posts that position liquid rhinoplasty as an “easy” way for individuals to get the nose of their dreams, Dr. Kontis said. At the same time, some clinicians, concerned about the risk of serious side effects, are shying away from the procedure.

“I’m conflicted regarding liquid rhinoplasty because I see quite a few problems surfacing, mostly from poor technique,” said Steven Dayan, MD, a Chicago-based facial plastic surgeon who is board certified by both the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology–Head and Neck Surgery. “The highest reported cases of blindness secondary to a filler complication come from injections in the nose, and every month, I get a phone call from someone who’s run into an unexpected vascular event, asking for help.”

Compounding the risk to patients is the fact that many physicians and non-physicians alike are not privy to the best practices and the latest in safe techniques for nasal filler injection. “The majority of people being trained today to perform this procedure are not board-certified otolaryngologists or the four core cosmetically trained physicians; they’re adjunct physicians and providers who may not have easy access to the latest in CME training or peer-reviewed resources,” Dr. Dayan said.

Dr. Kontis shares his concerns. “We doctors have always been very nervous about non-surgical rhinoplasty because of the risk of blindness and other complications, but as we start to see more paraprofessionals offering this procedure, we’ve become worried that we may see more complications,” she said.