March 27, 2023

non surgical rhinoplasty nose technique

Non-surgical rhinoplasty or a liquid nose job using dermal fillers and advanced injection techniques is very popular as an alternative to more invasive cosmetic surgery. Without proper training, this treatment presents significant risk for complications.

In this blog, Dr Tim Pearce will detail the ways aesthetic clinicians can reduce the risk of causing a pressure necrosis after a non-surgical rhinoplasty procedure, including the type of nose to avoid when assessing patient suitability for treatment.

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 to reduce complication risks when injecting the tip of the nose

Dr Tim Facial AnatomyTo avoid complications when injecting the nose, particularly the tip of the nose where there is a risk of pressure necrosis, there are several things we can do to reduce the risks, notes Dr Tim.

Educating the patient

The first is having an educated patient. You must explain the risks to your non-surgical rhinoplasty patients, without scaring them. They should understand that a little bit of redness is normal, but if it persists and is prolonged over several days then they are advised to let you know. If there is also pain post procedure, they absolutely must get in touch, and you should see them without delay.

Assessing the patient before treatment

Get into the habit of feeling people’s noses before you inject them, asserts Dr Tim. You should always sense if the tissue is too strongly adhered, for example. If you are presented with a patient who has a history of multiple surgical rhinoplasties or nasal trauma, their skin often becomes adhered to the surface, along with the presence of scar tissue. This means that there is no room to inject dermal filler, making them contraindicated for a non-surgical rhinoplasty due to the risk of causing a pressure complication; you should decline to treat in this instance.

By palpating a nose, it is an analogue skill, and you are assessing or sensing for movement and space within the nose – tissue should move easily, the nose should be mobile when you feel it, you should be able to lift the tip gently from the sides.

Assessing the nose in this way before you inject with filler will give you a rough idea of how easy, or how difficult this is going to be, and should make you stop injecting before you add too much product or cause you to reconsider if the procedure is a good idea before you start.

When it comes to the patient themselves, there is potentially an increased risk of nasal tip complications in individuals with a medical history of hypertension or high blood pressure.

Assessing Capillary Refill Time (CRT)

Assess capillary refill and capillary refill time (CRT) as you are performing the non-surgical nose treatment. Dr Tim maintains that he checks CRT around 50 times when he is injecting a nose – each time you inject, you check.

He notes that the benefit of this practice is that it helps you to get very good at knowing what normal capillary refill looks like in this area. Thus, if anything changes, you will pick it up and identify a problem much quicker than if you never checked for capillary refill. If you simply wait for a complication to occur, without employing steps to mitigate occurrence and reduce the risk, such as understanding what is normal for your patient, it will be much more difficult for you to assess a delay in blood flow with any certainty and intervene to solve the problem without support.

For more on the science behind non-surgical rhinoplasty complications, read up on why red nose tip could be pressure necrosis and spotting septum necrosis, a severe non-surgical rhinoplasty complication.

You can learn more advanced dermal filler procedures by training in liquid rhinoplasty. Further practical tips and advice can be found in Dr Tim’s blogs on how to safely perform a non-surgical rhinoplasty or liquid nose job and liquid nose job injection safety advice.

If you have any questions or comments about non-surgical rhinoplasty, you can find Dr Tim Pearce on Instagram.

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Aesthetics Mastery Show

Don’t Inject This Type Of Nose!

In this episode, Dr. Tim explains that there are a number of ways you can reduce the risk of causing a pressure necrosis after non-surgical rhinoplasty, and one of them is not injecting a certain type of nose… 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.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

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.

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