How to safely perform a non-surgical rhinoplasty or liquid nose job
Dr Tim Pearce describes how to perform a non-surgical rhinoplasty procedure, discussing his safety tips and advice to help you produce a perfect result for your patients. He will be providing answers to common questions from aesthetic clinicians about liquid nose jobs.
This blog accompanies the non-surgical rhinoplasty demonstration video featured as part of the Aesthetic Mastery Show, which also shows how Dr Tim used an ultrasound device to check the location of key blood vessels before injecting the patient with dermal fillers.
Do you feel anxious about causing complications? Many clinicians feel so overwhelmed with the thought of causing a vascular occlusion that it stops them growing their aesthetics business. Dr Tim is currently hosting a webinar series to help you overcome your fear of complications so that you can uplevel your knowledge, and increase your CPD-certified learning to build a successful aesthetics business. Sign up here >>
How do you prepare for a non-surgical rhinoplasty procedure?
Before starting any non-surgical rhinoplasty, Dr Tim palpates the nose to ascertain how much potential space there is within the structure. He believes that there is wide variation between noses, and not just based on sex or ethnicity. Some patients do not have room for the addition of dermal filler, thus, if you change the shape of the nose by adding product, you can compress the capillaries, causing compression necrosis or persistent redness. This ultimately leads to the patient requiring a reversal of the procedure using hyaluronidase.
He expresses concern that some injectors place too much emphasis on the aesthetic result – to achieve the great before and after photograph – only to discover a week later that they must reverse the procedure because there is so much redness caused by the increased pressure required to change the nose so dramatically with dermal filler.
Learn more about the non-surgical rhinoplasty complication of ‘red nose tip’ which could be pressure necrosis.
When assessing the patient, he is aiming to simplify the nose, ensuring that the two dorsal light reflexes become straight and are consistent all the way along the nose. Often these reflections are the easiest way to see how to beautify and simplify a nose, he confirms.
Prior to commencing the injections, Dr Tim can scan the patient’s nose using an ultrasound device which has become part of his routine clinical practice. He is looking for arteries in the areas which present a higher risk of vascular occlusion and checking for anatomical anomalies. Not sure if you need to invest, check out Dr Tim’s answers to the question, should I buy an ultrasound scanner for my aesthetic clinic?
Safe injection techniques for non-surgical rhinoplasty procedures
Dr Tim uses multiple additional steps as he performs a non-surgical rhinoplasty procedure to reduce the total risk of complication and intravascular injury, including aspiration.
Choose your entry point carefully
Look for the area of greatest curvature, when deciding on your entry point on the nose. Dr Tim warns clinicians to consider that if you elevate the nose superiorly rather than inferiorly, it can result in a dolphin or Avatar type appearance which many patients are mindful of, and that is not a desirable aesthetic result. He recommends choosing the point of greatest curvature to place the needle, aiming to elevate the tissue inferior to this point. Furthermore, you should palpate and use your fingers to get a sense of the nose before injecting; by adjusting with your finger, you can see if you like the aesthetic result.
Dr Tim recommends using a very small amount of dermal filler product with each injection. He explains that by placing the hyaluronic acid gel filler in a BD syringe there is limited scope to inject more than 0.05mls at a time; this is a very safe amount for avoiding the primary complication concern of blindness. Causing blindness from a non-surgical rhinoplasty procedure is a very rare event, but is completely avoidable when the right safety steps are taken, reassures Dr Tim.
He notes that above any dorsal hump is the highest risk area for vascular occlusion, which could affect the eyes. This complication is most easily avoided by injecting lower volumes of filler. Each time you inject, it ought to be a volume less than 0.085mls, which should make it impossible to occlude the vessel all the way back to the eyes. He proposes that to occlude this much of a vessel you would need to inject much more because a high viscosity filler does not flow easily that far back into the eye. Large volumes are likely to be associated with the blindness risk, but by using a BD syringe, you can ensure you are injecting very small amounts at a time.
He injects deep onto the periosteum, in the midline, having also used ultrasound prior to injecting to assess vessel size and location.
The needle is unprimed, making it as sensitive as possible to detect intravascular placement, giving additional reassurance that filler is flowing into a place that elevates tissue rather than into a vessel, which would not elevate. As Dr Tim injects, he watches for any signs of blanching which could indicate over pressurising of the tissue or intravascular placement.
Compress key arteries
Another top tip is to compress the likely position of the arteries as you inject to decrease the potential ability of the dermal filler to flow back. Dr Tim compresses the area where the supratrochlear artery may emerge from the orbit, reducing the chance of filler flowing back into this area. He highlights that this is simple physics – increase the pressure in the areas where we do not want filler to flow and it will make it less likely that the product will go in this direction; more likely resulting in less severe outcome even if there is a vascular occlusion, which will be easier to diagnose, treat, and prevent injury.
Buy a limited edition facial anatomy poster for your clinic as a helpful reminder of the vasculature of the face.
Mould and shape
Using his fingers Dr Tim can make small adjustments after the injections to ensure that the shape is correct, using gentle moulding manoeuvres. At this point, he will also check the capillary refill time in the treated area, as a best practice safety step.
Take your time
Dr Tim quips that of course it would be possible to perform a non-surgical rhinoplasty without doing the safety checks in 2 to 5 minutes – without aspirating, checking capability refill times, examining the nose, palpating etc. The reality is it that this demonstration case of a simple procedure to reduce a small bump on the bridge of the nose took closer to 15 to 20 minutes to perform, with multiple stages along the way. It is not about speed, notes Dr Tim; this is how he chooses to approach risk, using multiple ways to reduce the risk of causing significant injuries to patients.
Consider training in liquid rhinoplasty with Dr Tim and his team if you want to learn more about this advanced technique. If you have any questions or comments about non-surgical rhinoplasty, you can find Dr Tim Pearce on Instagram.
If you have any questions or comments about non-surgical rhinoplasty, you can find Dr Tim Pearce on Instagram.
Is your worst nightmare causing a VO?
If you want to be a great injector then you need to get over your fear of complications. Register here for the next webinar to help you overcome your complications anxiety >>
Aesthetics Mastery Show
How To Perform a Non-Surgical Rhinoplasty | Restoring Volume Loss
In this episode, Dr Tim discusses how to perform a simple non surgical rhinoplasty procedure. He walks listeners through his safety tips and advice to produce a perfect result for the patient. Dr Tim used an ultrasound to check the location of vessels before injecting. More info on the ultrasound used can be found at: www.clarius.com. Watch the full Aesthetics Mastery Show here.
The show has already had over 20 comments from practitioners.
Practitioner COPTARORS said:
“This is super safer than what the clinic I am working with has trained me, the technique they use is bending the needle first then inject retrograde linear thread without aspiration, for the dose they use, it was more than 0.05 ml per injection and I was like no no I won’t do this in my practice (I know that there is no need to aspirate when using retrograde injection, but still I feel more safer a little bit with aspiration). “
Patient Marie Born commented:
“I have irregular volume loss on the sides of the lower part of the nose and one side looks collapsed after closed surgical rhinoplasty. I also have a saddle nose instead of a sloped nose now. I think there is little room for filler. Can it still work?”
Dr Tim Pearce’s Clinical Advisor Mary replied:
“Some patients aren’t ideal candidates for nose filler as you have said. If there isn’t much mobility when the skin is pinched/ lifted the chance of changing the shape may significantly reduced. But it’s still worth visiting a practitioner who is experienced in non surgical rhinoplasty to obtain their opinion.”
Clinician Dr. G. asked:
“How do you prevent migration long term from patients who may sleep on their face or play sports?”
To which Dr Tim Pearce’s Clinical Advisor Mary responded:
“Encourage filler to settle well for a good 2 Weeks before compressing it with either head gear that affects the nose. Wear glasses lower depending where filler was placed.”
Read more questions and answers or join in the debate on our YouTube channel.
Filler Complications eLearning Courses
If you want to increase your confidence by learning how to handle complications, Dr Tim Pearce offers two comprehensive courses that are highly rated by our delegates:
Both give CPD and certificates on completion.
In addition, browse our FREE downloadable resources on complications.
Dr Tim Pearce eLearning
Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.
Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.