June 9, 2026 • 21 mins
What if one of the most popular non-surgical procedures in aesthetic medicine is also one of the most misunderstood?
In this episode of Plastic Surgery Uncensored, Dr. Rady Rahban takes an in-depth look at liquid rhinoplasty—a procedure that has surged in popularity thanks to its promise of immediate results, minimal downtime, and the ability to alter the appearance of the nose without surgery.
But beneath the appeal lies a far more complex reality.
Dr. Rahban breaks down what liquid rhinoplasty actually is, the anatomical principles that make it effective in certain situations, and why it is often being used to address concerns it was never designed to correct. He explains which patients may benefit from strategically placed filler, why others are poor candidates, and how an incomplete understanding of nasal anatomy can lead to devastating consequences.
This conversation goes far beyond social media transformations and before-and-after photos. It explores the limitations of filler, the importance of proper patient selection, and the potentially catastrophic complications that can occur when injections are performed in one of the most anatomically complex regions of the face—including vascular occlusion, tissue necrosis, and even blindness.
If you've ever considered a liquid rhinoplasty, been told filler can "fix" your nose, or want to understand the difference between temporary camouflage and true structural correction, this episode is essential listening.
Topics covered include:
• What liquid rhinoplasty actually is
• How filler can improve select nasal contour irregularities
• Who may be an appropriate candidate
• Why some noses should never be treated with filler
• The limitations of non-surgical nose reshaping
• Vascular occlusion and tissue necrosis explained
• The rare but devastating risk of blindness
• Why nasal anatomy matters
• Liquid rhinoplasty vs. surgical rhinoplasty
• When surgery is the more appropriate solution
This is a thoughtful, evidence-based discussion about one of aesthetic medicine's most controversial procedures—and the information every patient should understand before allowing anyone to inject their nose.
✨ If you enjoyed this episode of Plastic Surgery Uncensored:
✔️ Subscribe on Apple Podcasts, Spotify, or wherever you listen.
✔️ Rate & Review—your feedback helps more people find us.
✔️ Follow Dr. Rady Rahban across all platforms for daily insights, behind-the-scenes, and patient education:
In this episode of Plastic Surgery Uncensored, Dr. Rady Rahban takes an in-depth look at liquid rhinoplasty—a procedure that has surged in popularity thanks to its promise of immediate results, minimal downtime, and the ability to alter the appearance of the nose without surgery.
But beneath the appeal lies a far more complex reality.
Dr. Rahban breaks down what liquid rhinoplasty actually is, the anatomical principles that make it effective in certain situations, and why it is often being used to address concerns it was never designed to correct. He explains which patients may benefit from strategically placed filler, why others are poor candidates, and how an incomplete understanding of nasal anatomy can lead to devastating consequences.
This conversation goes far beyond social media transformations and before-and-after photos. It explores the limitations of filler, the importance of proper patient selection, and the potentially catastrophic complications that can occur when injections are performed in one of the most anatomically complex regions of the face—including vascular occlusion, tissue necrosis, and even blindness.
If you've ever considered a liquid rhinoplasty, been told filler can "fix" your nose, or want to understand the difference between temporary camouflage and true structural correction, this episode is essential listening.
Topics covered include:
• What liquid rhinoplasty actually is
• How filler can improve select nasal contour irregularities
• Who may be an appropriate candidate
• Why some noses should never be treated with filler
• The limitations of non-surgical nose reshaping
• Vascular occlusion and tissue necrosis explained
• The rare but devastating risk of blindness
• Why nasal anatomy matters
• Liquid rhinoplasty vs. surgical rhinoplasty
• When surgery is the more appropriate solution
This is a thoughtful, evidence-based discussion about one of aesthetic medicine's most controversial procedures—and the information every patient should understand before allowing anyone to inject their nose.
✨ If you enjoyed this episode of Plastic Surgery Uncensored:
✔️ Subscribe on Apple Podcasts, Spotify, or wherever you listen.
✔️ Rate & Review—your feedback helps more people find us.
✔️ Follow Dr. Rady Rahban across all platforms for daily insights, behind-the-scenes, and patient education:
- Instagram: @drradyrahban
- TikTok: @radyrahbanMD
- YouTube: @Rady Rahban
- Facebook: @Rady Rahban
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:07):
Welcome to another episode of Plastic Surgery on Censored. As always,
your host doctor Roddy Raband. So this week we're gonna
do a conversation about liquid rhinoplasty. So we're going to
talk about pros and cons. We're gonna talk about risks,
We're gonna talk about indications, What the hell is it?
Why are people doing it? Why should I do it?
Why shouldn't I do it? We're gonna talk about everything
there is to know about liquid rhinoplasis. As everyone knows,
(00:30):
I love rhinoplasti surgery. It's one of the areas that
I subspecialize. I do a ton of it, and to
be honest with you, I really do think that the
idea or the area of liquid rhinoplasty should be focused
on those who do real rhinoplasty. I think the problems
that liquid rhinoplasty can present, a lot of them are
(00:50):
due to the fact that regular injectors are doing it.
So I really think as you go through this and
you listen, you'll understand that if I decide to do
a liquid rhynoplasty, I probably should do it with someone
who does real rhinoplastis. At any rate. First thing, we
need to do. Is what we're going to talk about
why liquid rhinoplasty is so popular? Where did that start from?
(01:11):
Social media and all that. We're gonna talk about the
fact that, oh my god, you get to see like
immediate results, quick results, immediate gratification, all the buzzwords and
things we like today. In order for a procedure, everyone
wants to know, what's the holy grail? Can I do? Sir?
Can I do a procedure that's going to give me
immediate result, has no downtime and basically I don't have
(01:33):
to go into surgery. So everyone thinks that liquid rhinoplasty
is that, but not so quick. So let's just start
out with what the hell is liquid rhinoplasty? So? Liquid
rhinoplasty is a fancy term for using fillers to fill
in the nose to then create the illusion or the
(01:55):
camouflage that the nose is now better looking. Again, I'm
taking a substance, a filler, I'm sticking it in the nose,
and therefore, as a result, the nose looks better. So
right out of the gate, you understand that, Wait, you're
adding something to my nose, so my nose is going
to be bigger, right, Yeah, So that's the first thing
(02:18):
you need to understand. Generally speaking, rhinoplasty not always, but
in many instances is reducing the size, the bulk, the
projection of your nose, and therefore the idea of adding
volumes a little bit counterintuitive. So for sure, no matter
what anyone tells you, when the procedure is done, it
(02:39):
will be bigger. Now, the hopes is that your nose
has a better shape and as a result looks better
and as a result overall appears less obtrusive or obvious. Okay,
the next thing is what is this substance? What are
you guys sticking in it? And you're using filler? Well,
fillers are from A to Z. There's all kinds there
(02:59):
there's radis, which is calcium, there's voluma, there is sculpture, etc. So, unarguably,
the only product that should ever be stuck in the nose,
and even that is with great caution, is a hyaluronic
acid based product HA. And within the category of HA,
(03:20):
there are hundreds of fillers of different thicknesses, of different qualities.
If you're going to inject in your nose, in my opinion,
the only product that should ever be injected in the
nose is a thin filler such as wrestling. For me personally,
that's the only substance I use because, as you can imagine,
the nose is incredibly delicate, like the inside of a watch,
(03:42):
and some of these fillers are thick and pulling fluid,
and the last thing you want to do is be
shoving that inside your nose, which is this kind of
really sort of Faberge egg like structure. So that's that.
Let's move on to what are the pros well? Like?
Why should I do it? Am I? What are the
reasons to do well? Number one requires no anesthesia. You
(04:05):
literally go into an office, you're sitting in an exam room,
and you get the procedure done as if you were
getting filler put in your lips or your cheeks or etc.
In general, there's relatively little downtime. In other words, unlike
a surgery, which has a real surgical downtime, the filler
downtime should be zero if done correctly, and you don't
have much bruising to a day or two or three
(04:26):
with some mild bruising and swelling. You can see the
results when it's done in the right indication. Theoretically you
can look in the mirror five seconds after it's done
and be like, oh crap, that looks cool. Oh wow,
so much better. If you hate it, or if there's
a catastrophe, theoretically it can be reversed. And that's one
(04:46):
of the reasons why you should only use an HA
or hygaluronic acid based filler, because you can go into
the refrigerator, get an enzyme vit rate highly on a
days and inject it and that product goes away. As
a result, it's not actually a bad product for some
mild minor issues. Again, mild and minor issues. So what
(05:09):
are those mild and minor issues for which I'm a
pretty good candidate for a liquid mino plus Number one
is if you have some a very mild hump. The
most common indication and where I think it probably works
the best, is I don't have a huge hump, but
I have a small hump. And if you think and
(05:30):
look at a hump, there's a point in which the
hump starts. That area at the top of your nose
between your eyebrows, between your eyes is called the rate X.
That's the low point. Then the nose starts to swoop
upwards and then eventually comes back down. So the idea
of adding volume in the area that's low before the
(05:51):
hump starts will then fill that area, and you can
fill it up to the level of the hump or
slightly less. And yes, when you look at the side profile,
the hump will seem either gone or significantly less in
those instances. It's a great option because that area in
general is mobile. If you grab the skin between your eyebrows,
(06:14):
it's fleshy in moves, so it can accept filler, and
by adding volume you're basically making a straighter looking nose.
I don't mind that at all. The next thing where
it's not a bad idea is if your nose is
mildly crooked, in other words, it goes a little bit
to the left or a little bit to the right,
(06:36):
the area you fill it in the area in the
middle of the nose in which there's a concavity. So again,
if a nose curves curves a little bit to the right, curves,
that means above the tip there's a little dent where
the sea portion of the noses, and if you put
a little bit of filler in there, it'll look like
(06:59):
the nose is straighter, but the nose will be slightly wider.
Hence why it's only a good option if the curvature
is very mild, because a little bit of width doesn't
really matter, and the straightening is a significant improvement. The
next thing where it's pretty good for is people who
in general have just a flat bridge. I like my nose,
(07:20):
everything about it is great. I have no hump, but
my nose is a little low the bridge portion. Often
the case with ethnic noses, whether it's African American, Asian,
certain Latinos, etc. And as a result, you just add
a little bit of filler like you did in the RATEX,
except you added from the tip all the way to
the bridge, and the whole nose is raises up a
(07:43):
little bit again a little bit, it raises up a
little bit. The last area, which is a very tricky
area to do it is impatience who present who have
had rhinoplasts so their noses damage scar very stiff, and
to be honest with you, opening up the nose and
(08:04):
attempting to fix it again doing a revision rhino plossey
is going to end up catastrophically poor because you can't
just keep going back in and opening the nose and
opening the nose, there's a diminishing return in others at
some point, trying to revise it'll make it worse. And
that's why when patients call and they're like, hey, doctor Ramant,
I've had three previous rhinoplasties, can you help me? Sometimes
(08:24):
the answers no, And I truly suggest you don't touch it,
because you are the one who's telling me with every
revision it got worse. So it's not just always the
fact that the surgeons are poor. In those patients with
irregularities and bumps and lumps on their nose, their tip
is a little asymmetric. You can trickle a tiny amount
(08:45):
of filler throughout the nose and make the overall nose
look smoother without so many contru regularities. Why do I
say super tricky because in those patients, the blood supply
is less, the nose is super scarred, and the nose
does not want to receive this filler. As a result,
it can get risky for some of the risks that
(09:08):
we're gonna talk about. So, okay, those are the people
that can consider doing a liquid rhinoplasty. Who are the
people that should just not consider. Just stay away from it.
Number one. If your number one issue is my nose
is just large, like that's the main reason you should
forget about it. Because getting a liquid rhinoplasty just basically
is adding volume to your nose. It's not gonna fix
(09:30):
anything to do with your breathing. As a matter of fact,
if overdone, it'll actually make your breathing worse because it
makes your nose heavy. But for sure, if you have
deviated septums in fear turbin a hypertrophy, your valves collapse,
whatever the case is, forget about it. If you have
a significant hump, you're gonna raise the nose to the
level of the significant hump and your nose is just
(09:51):
going to be ginormous. You'll hate that if your nose
is droopy. Now, pay very close attention people. The majority
people who do liquid rhinoplasts are spas and doctors that
are not rhinoplasty specialists. So that shouldn't shock you. If
you come into my office and you say, hey, doctor Abon,
I don't like my nose. I can reach back into
(10:11):
my toolbox and I have twenty things to offer you.
And believe me, despite what you think. I'm not going
to reach for surgery. If you're a great candidate for
a liquid rhinoplasty, because I can do them all. Now,
if you come to me and I'm a SPA doctor,
and we all know from other episodes, that's whoever the
hell you're pediatrician, I know someone who's an er doctor,
you're a radiologist, frankly, your nurse practitioner, your injector, whoever.
(10:35):
And you say, hey, I don't like my nose. What
tools do they have? Just a filler, that's all they have.
So what do you think they're going to suggest to you?
Filler and they're going to try to do way more
than they should be doing with the instrument. They're going
to try to build you a shed with only a hammer. Well,
that's not going to happen. And one of the things
(10:56):
they try to do is many patients with bad noses
have very droopy tips, much like mine, and they suggest
to you that by injecting your tip, they can make
your bulbous tip fat and round, more refined, and they
can make your droopy tip rotated, and they'll show you
photo after photo. Well, maybe if your tip is mildly droopy,
(11:21):
and maybe if you have a little bit you can
get away with it, and I'll caution you why you shouldn't,
but certainly they're gonna if you have a major droup
or big bulbous tip, this is a disaster and I
think you're a terrible candidate for it, and you should
absolutely not do it. The last thing you need to
understand is obviously filler is temporary, and you're gonna have
to keep doing this, and every time you do this,
(11:43):
you get scar tissue. You develop a bunch of scar
tissue in your nose, because how do you think filler
goes away? Filler goes away through inflammation and absorption. Your
body absorbs it, but it doesn't absorb it without consequence.
There's an inflammation and an irritation that occurs in your
cheek or your jaw. Maybe it's insignificant, but in your nose,
(12:04):
small amounts of scar tissue is very significant. So let's
get to what I love talking about always, which is
what can go terribly wrong. Why are we even having
this conversation? Why are you concerned? Well, the nose, unlike
the lips and the cheeks, is super complicated, has a
lot of very specific anatomy and has a lot of
(12:24):
treacherous sort of quicksand areas that you need to know about.
Number one issue, you're injecting the nose, and inside the
nose and in the skin and in the musculature, is
a lot of big blood supply, lots of big arteries
that are feeding your nose. That's why when you get
a nose bleed, you bleed like stink. So something called
(12:45):
vascular occlusion. They're sticking in the filler. You cannot stick
filler in the nose with a canula. You have to
stick it in with a needle. That needle has to
be sharp. And you are blindly and I mean blindly,
just you have no idea. You're sticking that needle into
the nose and pushing the syringe and shoving filler. Well,
what happens if you accidentally pierce into one of those
(13:07):
arteries shove the filler and that filler goes into the
artery and plugs the end of the artery. You get
vascular occlusion and you get necrosis. What does that mean?
Dead skin of your nose turns black, falls off. Come on, doctor, remark, Yeah, necrosis.
You guys have seen pictures of toes and ear. Yes, necrosis,
(13:28):
It dies, the blood supply doesn't make it to the
tip or your nostril when we get off or even now,
once you pause this episode, google nose vascular occlusion, necrosis
of tip of nose filler boom, you're gonna see photos.
That'll be the end of it. You'll never ever want
to do filler again. It's catastrophic. And if they don't
catch it almost immediately, meaning oh my god, oh my god,
(13:49):
it's turning purple. Stick a bunch of enzyme in and
pray that they undo the blockage meaning rotorutered open. It's
permanent and it's game over. You then gonna have to
remove that skin into skin reconstruction, et cetera. So that's
air at risks number one, and it's purely blind. In
other words, no one can prepare you. You have to
know the anatomy, what areas the blood vessels are in,
(14:11):
how to pull the skin away, how to retract the
blood before you inject it. No one does that crap.
They just inject you and you get it over with.
The next thing is something called blindness. Blindness, what does
blindness have to do well? If it happens that you
shove this product into the wrong vessel, which happens to
(14:33):
communicate because your nose is right by your eye, and
go retrograde up to your eye, go into the artery
of the eye and go bloop straight to the end
of the eye. You go blind right there. And then
and if you google again, pause this episode, go on
and say an ocular occlusion from filler in the nose
or blindness. While it is not happening left, right and center,
(14:57):
it certainly is not unheard of, and it is again catastrophic. Obviously.
The next thing is that you can get just from
pushing the filler into the tip area. So that's let's
highlight the different areas of the nose. Anatomy matters, right,
So when you grab the bridge right between your eyebrows
and the bridge and pinch, you'll see that skin is
(15:18):
really loose. Therefore, when you put filler in the radex
between your eyes, it's loose area. So it's a big
bag and the filler goes in relatively easily. But now
try to grab your tip and in most instances you
can't grab anything because it's rigid skin that's very adherent
(15:39):
to the structure underneath. So if you start pushing filler
into the tip, hence why I'm not a fan of tipwork,
and you push hard enough, especially if you've ever had
a nose job before, you'll notice the skin blanching. That is,
the skin starts turning a little white because that's skin
(16:00):
is not getting blood supply, and if you push a
little too hard or put a little too much, you
will blanch aclude and kill that skin. So you can
get skin necrosis from either injecting an artery that artery
goes cut and blocks off an area like an entire nostril,
or just by shoving it into the tip where it's
(16:21):
kind of rigid and pushing it with a lot of
force and then the area starts blanching. I guarantee you're
going to see your injector start sweating because you're like,
oh crap, is this just temporary? Is this permanent? So
it's not an goes without issue risk as a result.
Although I like liquid rhinoplasty in the right candidate, I
(16:44):
am a staunch believer that it should only be done
by people who do rhinoplastis that's right, You heard it
from me. Anyone who's listening, they're gonna lose their shit.
In my office, we've recently opened a spa. We hire
different injectors. You know my stance, I'm kind of really
a bit critic. But there's a place, there's a there's
(17:04):
a there's a there's a skill level that's required for
certain things. And none of my providers are ever allowed
to inject noses. That's that's completely and totally restricted for
me because I do those jobs. I know the anatomy.
I'm the surgeon that takes the nose apart. And I
really do believe that while you want to get filler
put in your cheeks or your lips, or your temples
(17:27):
or your chin or your job, have at it. You
know my overall stance, But when it comes to nose,
I really think you should spend your time and find
someone who is an expert in noses. That means that
person can do anything you need and at the end
of the day, can help you. So that then leads like, Okay,
well when should I just say screw it and forget
(17:48):
this liquid rhinoplasty thing and do a kind of a
legit rhinoplasty. Well, number one, if you have any desire
for this nose to be permanent. Like you're twenty three
and you don't want to be doing filler in your
nose till you're fifty nine. So you do know that
filler in your nose costs money. If you add it
all up, you do the math, at some point you
will have paid for rhinoplasti and then some and two.
(18:10):
That scar tissue that keeps building and then goes away,
building and goes away is not ideal for your nose.
So if you have any desire to have permanency, the
quicker you get on with it, the better. The second
thing is if any of your issues are significant. My
hump is really big, my tip is very droopy, my
breathing sucks, my tip is very bulbous. Those things are
not going to be fixed with the liquiorinoplasty. Do not
(18:32):
be deceived by online images. Again, do not be deceived
when I'm telling you, if it's too good to be true,
it's not true. Oh my god, look at that before
and after. Do you know how much AI is on
the internet now, how much photomorphing, how much photoshop? It's insane.
There are images that people send to me every day,
(18:54):
every day, of before and after of necks, a breasts
of things. Hey, doctor, is this real? I'm like, hell no,
there is no way on earth that before and after
is real. Not because I'm a hater, because it's physically impossible. Like,
it's physically impossible. Right, So, as I said to you,
if your issues are mild, then they fall in the
(19:14):
categories I mentioned to you, no problem, try it. But
if your issues are any of the things I mentioned
to you, I would highly, highly suggest being careful. All right,
So all right, now I have a really good understanding.
Number One, I know what it is. Number two, I
know who's a good candidate for it. Number three, I
know what it can do, I know what it can't do,
(19:35):
and most importantly, as always, I know what can go
terribly wrong. So how do I go about it? Moving forward? So,
now that you have the lay of the land, if
you think that you're a good candidate for a liquid rhinoplasty,
number one, identify a high level rhinoplasty surgeon who does
those jobs, who can then do both liquid rhinoplast as
(20:00):
well as a traditional surgical rhinoplasty, because that person will
have the greatest understanding of the anatomy that you're about
to involve. Secondly, aesthetically, they of course will have the
best aesthetic judgment because they're the ones who can surgically
correct your nose, So I think that that's really important.
Third even if you go see a guy who's a
(20:22):
world renowned rhinoplasty guy and they're suggesting for you to
do things that I just told you is a bad idea,
then it's a bad idea. Like if you have a
super droopy tip, don't do it. If you have a
three time revision scar down nose, don't do it. If
your hump is ginormous, don't do it. You follow what
I'm saying, And I think if you go about it
the way I mentioned to you, I do think it's
(20:43):
as everything a great tool. A screwdriver is a great tool.
Just make sure you're screwing in a screw and not
screwing in a nail. Really, that's it, all right, guys.
I hope that was a helpful synopsis of Liquid rhinoplastis
using domes as always, And I ask you my two
favorite requests at the end of every episode. Number One,
if you enjoy our show, which I hope you do,
(21:06):
please share this with friends and family. You guys, are
you know listening and hopefully you find it helpful. You
never know who you know as literally tomorrow going to
get a liquid ryino plasty, god forbid. They get into
crosis and they mentioned it to you and you're like, oh, crap,
I just heard that episode, so help disseminate the information.
And then lastly, we love it. We're grateful, we're appreciative.
(21:26):
When you guys share your thoughts and your reviews, it
just literally makes everyone feel better about the show. We're
so grateful for your feedback. All right, guys, that's a rap.
As always, I'm your host, doctor Roddy Raban, and we
will hear you. See you next week on plastic Surgery
on Sense.
Welcome to another episode of Plastic Surgery on Censored. As always,
your host doctor Roddy Raband. So this week we're gonna
do a conversation about liquid rhinoplasty. So we're going to
talk about pros and cons. We're gonna talk about risks,
We're gonna talk about indications, What the hell is it?
Why are people doing it? Why should I do it?
Why shouldn't I do it? We're gonna talk about everything
there is to know about liquid rhinoplasis. As everyone knows,
(00:30):
I love rhinoplasti surgery. It's one of the areas that
I subspecialize. I do a ton of it, and to
be honest with you, I really do think that the
idea or the area of liquid rhinoplasty should be focused
on those who do real rhinoplasty. I think the problems
that liquid rhinoplasty can present, a lot of them are
(00:50):
due to the fact that regular injectors are doing it.
So I really think as you go through this and
you listen, you'll understand that if I decide to do
a liquid rhynoplasty, I probably should do it with someone
who does real rhinoplastis. At any rate. First thing, we
need to do. Is what we're going to talk about
why liquid rhinoplasty is so popular? Where did that start from?
(01:11):
Social media and all that. We're gonna talk about the
fact that, oh my god, you get to see like
immediate results, quick results, immediate gratification, all the buzzwords and
things we like today. In order for a procedure, everyone
wants to know, what's the holy grail? Can I do? Sir?
Can I do a procedure that's going to give me
immediate result, has no downtime and basically I don't have
(01:33):
to go into surgery. So everyone thinks that liquid rhinoplasty
is that, but not so quick. So let's just start
out with what the hell is liquid rhinoplasty? So? Liquid
rhinoplasty is a fancy term for using fillers to fill
in the nose to then create the illusion or the
(01:55):
camouflage that the nose is now better looking. Again, I'm
taking a substance, a filler, I'm sticking it in the nose,
and therefore, as a result, the nose looks better. So
right out of the gate, you understand that, Wait, you're
adding something to my nose, so my nose is going
to be bigger, right, Yeah, So that's the first thing
(02:18):
you need to understand. Generally speaking, rhinoplasty not always, but
in many instances is reducing the size, the bulk, the
projection of your nose, and therefore the idea of adding
volumes a little bit counterintuitive. So for sure, no matter
what anyone tells you, when the procedure is done, it
(02:39):
will be bigger. Now, the hopes is that your nose
has a better shape and as a result looks better
and as a result overall appears less obtrusive or obvious. Okay,
the next thing is what is this substance? What are
you guys sticking in it? And you're using filler? Well,
fillers are from A to Z. There's all kinds there
(02:59):
there's radis, which is calcium, there's voluma, there is sculpture, etc. So, unarguably,
the only product that should ever be stuck in the nose,
and even that is with great caution, is a hyaluronic
acid based product HA. And within the category of HA,
(03:20):
there are hundreds of fillers of different thicknesses, of different qualities.
If you're going to inject in your nose, in my opinion,
the only product that should ever be injected in the
nose is a thin filler such as wrestling. For me personally,
that's the only substance I use because, as you can imagine,
the nose is incredibly delicate, like the inside of a watch,
(03:42):
and some of these fillers are thick and pulling fluid,
and the last thing you want to do is be
shoving that inside your nose, which is this kind of
really sort of Faberge egg like structure. So that's that.
Let's move on to what are the pros well? Like?
Why should I do it? Am I? What are the
reasons to do well? Number one requires no anesthesia. You
(04:05):
literally go into an office, you're sitting in an exam room,
and you get the procedure done as if you were
getting filler put in your lips or your cheeks or etc.
In general, there's relatively little downtime. In other words, unlike
a surgery, which has a real surgical downtime, the filler
downtime should be zero if done correctly, and you don't
have much bruising to a day or two or three
(04:26):
with some mild bruising and swelling. You can see the
results when it's done in the right indication. Theoretically you
can look in the mirror five seconds after it's done
and be like, oh crap, that looks cool. Oh wow,
so much better. If you hate it, or if there's
a catastrophe, theoretically it can be reversed. And that's one
(04:46):
of the reasons why you should only use an HA
or hygaluronic acid based filler, because you can go into
the refrigerator, get an enzyme vit rate highly on a
days and inject it and that product goes away. As
a result, it's not actually a bad product for some
mild minor issues. Again, mild and minor issues. So what
(05:09):
are those mild and minor issues for which I'm a
pretty good candidate for a liquid mino plus Number one
is if you have some a very mild hump. The
most common indication and where I think it probably works
the best, is I don't have a huge hump, but
I have a small hump. And if you think and
(05:30):
look at a hump, there's a point in which the
hump starts. That area at the top of your nose
between your eyebrows, between your eyes is called the rate X.
That's the low point. Then the nose starts to swoop
upwards and then eventually comes back down. So the idea
of adding volume in the area that's low before the
(05:51):
hump starts will then fill that area, and you can
fill it up to the level of the hump or
slightly less. And yes, when you look at the side profile,
the hump will seem either gone or significantly less in
those instances. It's a great option because that area in
general is mobile. If you grab the skin between your eyebrows,
(06:14):
it's fleshy in moves, so it can accept filler, and
by adding volume you're basically making a straighter looking nose.
I don't mind that at all. The next thing where
it's not a bad idea is if your nose is
mildly crooked, in other words, it goes a little bit
to the left or a little bit to the right,
(06:36):
the area you fill it in the area in the
middle of the nose in which there's a concavity. So again,
if a nose curves curves a little bit to the right, curves,
that means above the tip there's a little dent where
the sea portion of the noses, and if you put
a little bit of filler in there, it'll look like
(06:59):
the nose is straighter, but the nose will be slightly wider.
Hence why it's only a good option if the curvature
is very mild, because a little bit of width doesn't
really matter, and the straightening is a significant improvement. The
next thing where it's pretty good for is people who
in general have just a flat bridge. I like my nose,
(07:20):
everything about it is great. I have no hump, but
my nose is a little low the bridge portion. Often
the case with ethnic noses, whether it's African American, Asian,
certain Latinos, etc. And as a result, you just add
a little bit of filler like you did in the RATEX,
except you added from the tip all the way to
the bridge, and the whole nose is raises up a
(07:43):
little bit again a little bit, it raises up a
little bit. The last area, which is a very tricky
area to do it is impatience who present who have
had rhinoplasts so their noses damage scar very stiff, and
to be honest with you, opening up the nose and
(08:04):
attempting to fix it again doing a revision rhino plossey
is going to end up catastrophically poor because you can't
just keep going back in and opening the nose and
opening the nose, there's a diminishing return in others at
some point, trying to revise it'll make it worse. And
that's why when patients call and they're like, hey, doctor Ramant,
I've had three previous rhinoplasties, can you help me? Sometimes
(08:24):
the answers no, And I truly suggest you don't touch it,
because you are the one who's telling me with every
revision it got worse. So it's not just always the
fact that the surgeons are poor. In those patients with
irregularities and bumps and lumps on their nose, their tip
is a little asymmetric. You can trickle a tiny amount
(08:45):
of filler throughout the nose and make the overall nose
look smoother without so many contru regularities. Why do I
say super tricky because in those patients, the blood supply
is less, the nose is super scarred, and the nose
does not want to receive this filler. As a result,
it can get risky for some of the risks that
(09:08):
we're gonna talk about. So, okay, those are the people
that can consider doing a liquid rhinoplasty. Who are the
people that should just not consider. Just stay away from it.
Number one. If your number one issue is my nose
is just large, like that's the main reason you should
forget about it. Because getting a liquid rhinoplasty just basically
is adding volume to your nose. It's not gonna fix
(09:30):
anything to do with your breathing. As a matter of fact,
if overdone, it'll actually make your breathing worse because it
makes your nose heavy. But for sure, if you have
deviated septums in fear turbin a hypertrophy, your valves collapse,
whatever the case is, forget about it. If you have
a significant hump, you're gonna raise the nose to the
level of the significant hump and your nose is just
(09:51):
going to be ginormous. You'll hate that if your nose
is droopy. Now, pay very close attention people. The majority
people who do liquid rhinoplasts are spas and doctors that
are not rhinoplasty specialists. So that shouldn't shock you. If
you come into my office and you say, hey, doctor Abon,
I don't like my nose. I can reach back into
(10:11):
my toolbox and I have twenty things to offer you.
And believe me, despite what you think. I'm not going
to reach for surgery. If you're a great candidate for
a liquid rhinoplasty, because I can do them all. Now,
if you come to me and I'm a SPA doctor,
and we all know from other episodes, that's whoever the
hell you're pediatrician, I know someone who's an er doctor,
you're a radiologist, frankly, your nurse practitioner, your injector, whoever.
(10:35):
And you say, hey, I don't like my nose. What
tools do they have? Just a filler, that's all they have.
So what do you think they're going to suggest to you?
Filler and they're going to try to do way more
than they should be doing with the instrument. They're going
to try to build you a shed with only a hammer. Well,
that's not going to happen. And one of the things
(10:56):
they try to do is many patients with bad noses
have very droopy tips, much like mine, and they suggest
to you that by injecting your tip, they can make
your bulbous tip fat and round, more refined, and they
can make your droopy tip rotated, and they'll show you
photo after photo. Well, maybe if your tip is mildly droopy,
(11:21):
and maybe if you have a little bit you can
get away with it, and I'll caution you why you shouldn't,
but certainly they're gonna if you have a major droup
or big bulbous tip, this is a disaster and I
think you're a terrible candidate for it, and you should
absolutely not do it. The last thing you need to
understand is obviously filler is temporary, and you're gonna have
to keep doing this, and every time you do this,
(11:43):
you get scar tissue. You develop a bunch of scar
tissue in your nose, because how do you think filler
goes away? Filler goes away through inflammation and absorption. Your
body absorbs it, but it doesn't absorb it without consequence.
There's an inflammation and an irritation that occurs in your
cheek or your jaw. Maybe it's insignificant, but in your nose,
(12:04):
small amounts of scar tissue is very significant. So let's
get to what I love talking about always, which is
what can go terribly wrong. Why are we even having
this conversation? Why are you concerned? Well, the nose, unlike
the lips and the cheeks, is super complicated, has a
lot of very specific anatomy and has a lot of
(12:24):
treacherous sort of quicksand areas that you need to know about.
Number one issue, you're injecting the nose, and inside the
nose and in the skin and in the musculature, is
a lot of big blood supply, lots of big arteries
that are feeding your nose. That's why when you get
a nose bleed, you bleed like stink. So something called
(12:45):
vascular occlusion. They're sticking in the filler. You cannot stick
filler in the nose with a canula. You have to
stick it in with a needle. That needle has to
be sharp. And you are blindly and I mean blindly,
just you have no idea. You're sticking that needle into
the nose and pushing the syringe and shoving filler. Well,
what happens if you accidentally pierce into one of those
(13:07):
arteries shove the filler and that filler goes into the
artery and plugs the end of the artery. You get
vascular occlusion and you get necrosis. What does that mean?
Dead skin of your nose turns black, falls off. Come on, doctor, remark, Yeah, necrosis.
You guys have seen pictures of toes and ear. Yes, necrosis,
(13:28):
It dies, the blood supply doesn't make it to the
tip or your nostril when we get off or even now,
once you pause this episode, google nose vascular occlusion, necrosis
of tip of nose filler boom, you're gonna see photos.
That'll be the end of it. You'll never ever want
to do filler again. It's catastrophic. And if they don't
catch it almost immediately, meaning oh my god, oh my god,
(13:49):
it's turning purple. Stick a bunch of enzyme in and
pray that they undo the blockage meaning rotorutered open. It's
permanent and it's game over. You then gonna have to
remove that skin into skin reconstruction, et cetera. So that's
air at risks number one, and it's purely blind. In
other words, no one can prepare you. You have to
know the anatomy, what areas the blood vessels are in,
(14:11):
how to pull the skin away, how to retract the
blood before you inject it. No one does that crap.
They just inject you and you get it over with.
The next thing is something called blindness. Blindness, what does
blindness have to do well? If it happens that you
shove this product into the wrong vessel, which happens to
(14:33):
communicate because your nose is right by your eye, and
go retrograde up to your eye, go into the artery
of the eye and go bloop straight to the end
of the eye. You go blind right there. And then
and if you google again, pause this episode, go on
and say an ocular occlusion from filler in the nose
or blindness. While it is not happening left, right and center,
(14:57):
it certainly is not unheard of, and it is again catastrophic. Obviously.
The next thing is that you can get just from
pushing the filler into the tip area. So that's let's
highlight the different areas of the nose. Anatomy matters, right,
So when you grab the bridge right between your eyebrows
and the bridge and pinch, you'll see that skin is
(15:18):
really loose. Therefore, when you put filler in the radex
between your eyes, it's loose area. So it's a big
bag and the filler goes in relatively easily. But now
try to grab your tip and in most instances you
can't grab anything because it's rigid skin that's very adherent
(15:39):
to the structure underneath. So if you start pushing filler
into the tip, hence why I'm not a fan of tipwork,
and you push hard enough, especially if you've ever had
a nose job before, you'll notice the skin blanching. That is,
the skin starts turning a little white because that's skin
(16:00):
is not getting blood supply, and if you push a
little too hard or put a little too much, you
will blanch aclude and kill that skin. So you can
get skin necrosis from either injecting an artery that artery
goes cut and blocks off an area like an entire nostril,
or just by shoving it into the tip where it's
(16:21):
kind of rigid and pushing it with a lot of
force and then the area starts blanching. I guarantee you're
going to see your injector start sweating because you're like,
oh crap, is this just temporary? Is this permanent? So
it's not an goes without issue risk as a result.
Although I like liquid rhinoplasty in the right candidate, I
(16:44):
am a staunch believer that it should only be done
by people who do rhinoplastis that's right, You heard it
from me. Anyone who's listening, they're gonna lose their shit.
In my office, we've recently opened a spa. We hire
different injectors. You know my stance, I'm kind of really
a bit critic. But there's a place, there's a there's
(17:04):
a there's a there's a skill level that's required for
certain things. And none of my providers are ever allowed
to inject noses. That's that's completely and totally restricted for
me because I do those jobs. I know the anatomy.
I'm the surgeon that takes the nose apart. And I
really do believe that while you want to get filler
put in your cheeks or your lips, or your temples
(17:27):
or your chin or your job, have at it. You
know my overall stance, But when it comes to nose,
I really think you should spend your time and find
someone who is an expert in noses. That means that
person can do anything you need and at the end
of the day, can help you. So that then leads like, Okay,
well when should I just say screw it and forget
(17:48):
this liquid rhinoplasty thing and do a kind of a
legit rhinoplasty. Well, number one, if you have any desire
for this nose to be permanent. Like you're twenty three
and you don't want to be doing filler in your
nose till you're fifty nine. So you do know that
filler in your nose costs money. If you add it
all up, you do the math, at some point you
will have paid for rhinoplasti and then some and two.
(18:10):
That scar tissue that keeps building and then goes away,
building and goes away is not ideal for your nose.
So if you have any desire to have permanency, the
quicker you get on with it, the better. The second
thing is if any of your issues are significant. My
hump is really big, my tip is very droopy, my
breathing sucks, my tip is very bulbous. Those things are
not going to be fixed with the liquiorinoplasty. Do not
(18:32):
be deceived by online images. Again, do not be deceived
when I'm telling you, if it's too good to be true,
it's not true. Oh my god, look at that before
and after. Do you know how much AI is on
the internet now, how much photomorphing, how much photoshop? It's insane.
There are images that people send to me every day,
(18:54):
every day, of before and after of necks, a breasts
of things. Hey, doctor, is this real? I'm like, hell no,
there is no way on earth that before and after
is real. Not because I'm a hater, because it's physically impossible. Like,
it's physically impossible. Right, So, as I said to you,
if your issues are mild, then they fall in the
(19:14):
categories I mentioned to you, no problem, try it. But
if your issues are any of the things I mentioned
to you, I would highly, highly suggest being careful. All right,
So all right, now I have a really good understanding.
Number One, I know what it is. Number two, I
know who's a good candidate for it. Number three, I
know what it can do, I know what it can't do,
(19:35):
and most importantly, as always, I know what can go
terribly wrong. So how do I go about it? Moving forward? So,
now that you have the lay of the land, if
you think that you're a good candidate for a liquid rhinoplasty,
number one, identify a high level rhinoplasty surgeon who does
those jobs, who can then do both liquid rhinoplast as
(20:00):
well as a traditional surgical rhinoplasty, because that person will
have the greatest understanding of the anatomy that you're about
to involve. Secondly, aesthetically, they of course will have the
best aesthetic judgment because they're the ones who can surgically
correct your nose, So I think that that's really important.
Third even if you go see a guy who's a
(20:22):
world renowned rhinoplasty guy and they're suggesting for you to
do things that I just told you is a bad idea,
then it's a bad idea. Like if you have a
super droopy tip, don't do it. If you have a
three time revision scar down nose, don't do it. If
your hump is ginormous, don't do it. You follow what
I'm saying, And I think if you go about it
the way I mentioned to you, I do think it's
(20:43):
as everything a great tool. A screwdriver is a great tool.
Just make sure you're screwing in a screw and not
screwing in a nail. Really, that's it, all right, guys.
I hope that was a helpful synopsis of Liquid rhinoplastis
using domes as always, And I ask you my two
favorite requests at the end of every episode. Number One,
if you enjoy our show, which I hope you do,
(21:06):
please share this with friends and family. You guys, are
you know listening and hopefully you find it helpful. You
never know who you know as literally tomorrow going to
get a liquid ryino plasty, god forbid. They get into
crosis and they mentioned it to you and you're like, oh, crap,
I just heard that episode, so help disseminate the information.
And then lastly, we love it. We're grateful, we're appreciative.
(21:26):
When you guys share your thoughts and your reviews, it
just literally makes everyone feel better about the show. We're
so grateful for your feedback. All right, guys, that's a rap.
As always, I'm your host, doctor Roddy Raban, and we
will hear you. See you next week on plastic Surgery
on Sense.
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