August 7, 2023

Dr Tim Pearce Anatomy Mannequin

Aesthetic clinicians are usually warned against injecting a nose with dermal filler for a liquid nose job or non-surgical rhinoplasty if the nose has previously been broken after suffering injury or as part of a surgical rhinoplasty. This should, however, not be an immediate contraindication.

In this blog, Dr Tim Pearce will shed light on how you can safely inject a nose that has previously been injured, broken, or undergone a surgical rhinoplasty, exploring the risks and additional safety checks required to determine suitability, along with appropriate injection techniques.

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 >>

Why you should not inject the nose of a patient who has had a surgical rhinoplasty

Nose anatomy for aestheticsIf you are concerned about treating patients who have had previous surgery or injuries to their noses, you are not alone. As aesthetic clinicians, we are often told in training courses and by conference speakers that you should NEVER treat a patient with dermal fillers for a liquid rhinoplasty if they have previously had a surgical rhinoplasty.

The reasons given for this contraindication relate to the tightness of the collagen around the nose and the potential space available to expand the tissue. Similarly, there is potentially less blood flow to the nose because surgeons will sometimes tie off arteries during the surgical rhinoplasty procedure, for example, the columella artery, resulting in less blood flow to the skin and more pressure because of more connective tissue.

How can you safely perform a liquid rhinoplasty on a patient who has previously had a surgical rhinoplasty?

Dr Tim explains that the first thing he does with all non-surgical rhinoplasty patients is feel for any adhesions, which would be more common in those with a history of previous injury to the nose or surgical rhinoplasty.

If you are presented with a nose that is very tightly stuck down to the surface of the bone, the periosteum, or the cartilage, then there is much less room to inject the dermal filler and this patient would be a complete contraindication and you should not inject. If you were to inject a nose like this, you would see a white bleb arise when you inject indicating the pressure from the filler which is squeezing blood out of the capillaries instead of lifting the skin off the periosteum. You can usually massage this away if you pick it up immediately, but you should not inject any further to avoid a more serious compromise to the nose.

For more advice on avoiding complications when injecting the nose and assessing patients appropriately before treatment, read non-surgical rhinoplasty: do not inject this type of nose and non-surgical rhinoplasty complication: red nose tip could be pressure necrosis.

If you have tested the nose and are satisfied that there is enough available space in a patient with a history of nasal surgery or trauma, you should aspirate, inject small amounts of filler at a time, and check capillary refill after every injection. Dr Tim combines this approach with ultrasound to confirm the location of blood vessels, which may be altered post-surgery, and to validate blood flow alongside capillary refill tests as he injects to allow him to inject with more confidence that he is doing so safely.

Other safety checks to consider are linked to observation and analysis of the nose you are about to treat – the straightness or lack thereof, indentations, and other anomalies related to the contours of the nose. Dr Tim revealed how he looks very carefully at the reflection of light on the nose. If you ask the patient to rotate their head from left to right, it will often reveal the contours of the nose with more detail and complexities or anomalies related to the past trauma will be easier to spot. Similarly, you can move your own head to view the nose from different angles and review the light reflex as it moves over the surface of the nose. This will allow you to target and treat to remove complexities.

Putting a little bend on the needle makes it easier to approach the nose from a different angle, and to access the right depth and position which will potentially increase the safety of injection as the needle touches the periosteum. It is bent in such a way that the bevel is down to decrease the potential space where you may be able to get into a vessel. For more on this, read how to bend your needle for better results in facial aesthetics.

Watch the full video below for a non-surgical rhinoplasty treatment demonstration in a patient with a history of surgical rhinoplasty by Dr Tim Pearce.

Get more practical insight into liquid rhinoplasty with these additional blogs from Dr Tim on how to safely perform a non-surgical rhinoplasty or liquid nose job and non-surgical rhinoplasty: liquid nose job injection safety advice.

You can find Dr Tim Pearce on Instagram.

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Aesthetics Mastery Show

How to safely inject a previously broken noseDr. Tim says:

“Injecting a nose that has undergone a surgical rhinoplasty is a topic we often hear being approached with caution. However, I believe it’s important to recognise that it’s not an absolute restriction. In this episode, I aim to shed light on how it can be done safely and responsibly by showing you how it’s done in action. I discuss the crucial safety steps that must be taken into account when considering this procedure. While injecting a nose that has been previously broken and undergone surgical rhinoplasty is feasible, it does come with some additional risks that we need to be aware of. Understanding these risks will help us make informed decisions and ensure the best possible outcomes for our patients. “

Watch the full Aesthetics Mastery Show here.


The show has already had over 6k views in less than a week and a number of comments from practitioners and patients.

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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