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Leading aesthetic doctors on whether nose filler can really rival rhinoplasty

Whether referred to as a 'non-surgical nose job/rhinoplasty/reshaping', 'liquid nose job' or simply 'nose filler', the aesthetic treatment promising to redefine the shape of one's nose continues to rise.

"More and more aesthetic practitioners are performing this procedure globally," says Dr Ashwin Soni, plastic and reconstructive surgeon and founder of The Soni Clinic. "They do, however, continue to be one of the highest risk treatment areas with filler, so choosing a highly qualified medical provider who has extensive knowledge of anatomy is imperative."

Here, Dr Soni and Dr Nikola Milojevic, an aesthetic doctor and owner of the Milo Clinic, reveal all there is to know about how non-surgical nose jobs actually work, who they're best suited to, the results and the risks – plus, how to find a trusted practitioner.

“By carefully injecting dermal filler above and below the ‘bump’ on the nose, we can very easily make the most ‘hooked’ of noses look completely straight,” says Dr Milojevic. “Additionally, by applying filler around the tip of the nose, we can make it look thinner and more refined, and can further lift the tip of the nose by injecting Botox into the depressor nasalis, the muscle which continuously pulls the nose down.”

Dr Soni adds: “A non-surgical rhinoplasty is suited to patients with a drooping nasal tip, or a bump – known as a ‘dorsal hump’ of the nose ­– that bothers them. The strategic placement of filler in a non-surgical rhinoplasty can improve the nasal tip, lift the tip, and straighten the side profile by correcting the bump.”

“Through a tiny needle we inject a hyaluronic acid filler, the typical ones being Juvéderm and Restylane Perlane, into the areas it is needed, almost like a sculptor. Once done, we mould it a little bit, and finally give the patient aftercare instructions, such as not to wear sunglasses for a little while,” Dr Milojevic explains. “The full non-surgical nose job procedure takes only 10-to-15 minutes, and the results are instantaneous.”

Dr Soni adds, “There is a strategy in terms of the order of what part of the nose to start with and what to end with. The results are instant, but I always advise my patients to wait a few days for the mild swelling to settle down. I personally see all my patients back for a follow-up at a month to see how it has settled out.”

“We now have more and more options for performing non-surgical procedures. Being non-surgical it means less risk, less downtime, and fewer side effects. We can do so much in just five minutes and with no pain. Surgical rhinoplasty, however, takes a month or longer to recover from and results are not always perfect.”

As a plastic surgeon, Dr Soni has extensive experience of doing both surgical and non-surgical rhinoplasties, which allows him the experience to be able to guide patients in the direction that works for their goals and particular anatomy. “The only way to really know whether you would be a suitable candidate for a non-surgical rhinoplasty or surgical rhinoplasty is to a consult an experienced provider,” he says.

In addition to the advantages of a non-surgical rhinoplasty noted above, there are some disadvantages to note: "You cannot make the nose narrower or slimmer, and cannot address any internal narrowing – and in those cases I would recommend a formal surgical rhinoplasty.”

A post shared by Dr Nikola Milojevic (@thebotoxking)

“The rise of the selfie over the years, shared on all social media platforms, has definitely influenced the rise of non-surgical rhinoplasties," Dr Soni feels. "Often these photos are taken at unflattering angles, and at that 45-degree angle, you can often see the bump or drooping nasal tip quite clearly.

"More and more patients are becoming aware of filler rhinoplasty, and so as this spreads across different platforms, an increasing number of people are booking in for one.” Dr Milojevic concurs. “We are living in a fast-paced society, and people want things done quickly and efficiently, yet with an affordable price point making it more accessible to them.”

Dr Milojevic notes that “filler is not permanent, so if you don’t like the results, you can wait a few months, or have the procedure reversed by professionally dissolving the filler." Given that a surgical nose job is permanent, he now finds people are turning to non-surgical fillers to correct rhinoplasty which has gone wrong, "which goes to show it can be the better option”.

“It is possible to dissolve filler if you wanted to reverse the results, but you don’t want to do that unless it really is an issue,” says Dr Soni. “I have never had to dissolve my own filler in practice and would hope that I don’t need to as it can affect your normal tissues too, and does not just break down the filler. So yes, this is a reversible procedure, but dissolving can be avoided with a great discussion before you go ahead, and making sure that you fully trust the provider when you come out of that consultation.”

Dr Milojevic explains, “we use modern fillers which contain some local anaesthetic in them, and this coupled with our light-handed technique, makes the procedure quick and painless.” Dr Soni adds that he uses a number of ways in order to minimise discomfort, “from local anaesthetic cream to ice packs to the smallest needles I can use for the particular procedure”.

A post shared by The Soni Clinic (@thesoniclinic)

According to Dr Milojevic, “As we do not move the nose that much, the results can last as long as 12-to-18 months, and with repeat treatments, they can last even longer.” Dr Soni finds that the results last on average between 12 and 24 months.

“Juvéderm and Restylane Perlane, which are often used in this procedure, are biocompatible and biodegradable products which means that it is not harmful to the body and is broken down and removed from the body naturally,” explains Dr Milojevic. “These hyaluronic acid nose fillers come in the form of a sterile gel produced in the laboratory.”

Dr Soni feels that non-surgical nose jobs are indeed safe in the right hands, but being are one of the higher risk filler procedures, it is imperative to see the most experienced practitioner possible. “I also use amazing quality filler, and personally use the Swiss filler brand Teoxane, which will metabolise and be broken down by the body naturally.”

Dr Milojevic explains that some injection-related side effects can occur including redness, tenderness, swelling and bruising. "None of these are ever very serious and they will resolve in a matter of days." As with all cosmetic filler, in addition, there is the risk associated with the filler itself, "including allergy, necrosis and blindness" – thanks to the filler blocking a blood vessel.

Dr Soni warns that there is a significant lack of regulation in the UK regarding aesthetic-based treatments and injectables. “Given that this is a higher risk procedure with filler, ensure you do your homework on your provider. One should look on the respective providers governing bodies to ensure that they have a medical licence to practice, for example the General Medical Council for Doctors (GMC) is a good place to start. Study their website and know where and what their training consists of. This is not a procedure that you want performed by a non-medical professional. There can be serious risks if the provider is not exceptionally well-trained, so please don’t pick a provider simply based on cost of treatment.”

“Firstly, the number one priority is to research your chosen provider well,” Dr Soni reiterates. “Prior to embarking upon any procedure, it is important you have a lengthy discussion with your provider about what can realistically be achieved with a non-surgical consultation and whether you would be happy with that. Also, please study a provider’s 'before and after' photos to make sure that your aesthetic goals align with the types of results that they offer. You should also be aware of what the filler is that your provider is using, and ensure that it is hyaluronic acid based, and is the highest quality product. Finally, it is really important to check that a clinic or provider has an out of hours number that you can message or call in case of any issues. You should have a way of contacting that clinic if you needed to.”