Tutorial: Safely fixing nose asymmetry with fillers (liquid rhinoplasty)

Non-surgical rhinoplasty or liquid nose jobs can be fraught with complexity, especially in patients with cosmetic concerns requiring significant correction.

In this blog, Dr Tim Pearce discusses a tutorial where he tackled a complex nasal correction case. The patient was concerned about a dorsal hump, asymmetrical shape, and nose curvature that appeared differently in various lighting. You can learn how to achieve a straighter, more balanced nose which can involve navigating around and even switching techniques to avoid the presence of crucial arteries to achieve great results, alongside other vital safety steps. Watch Dr Tim’s full tutorial video demonstrating safely fixing nose asymmetry and a dorsal hump.

If you are interested in learning more about facial anatomy to become a great injector and find your route to safer delivery and millimetre precision, get signed up for the Ultimate 3D Anatomy Experience from Dr Tim Pearce.

Medical professionals are taught anatomy in 2D textbooks, but in real life, anatomy is not flat. This educational opportunity is specifically for aesthetic injectors to help you level up your anatomy knowledge, get comfortable with anatomical variations, and boost your injection safety and confidence in a way that no cadaver course could ever deliver.

Get on the waiting list for updates when the Ultimate 3D Anatomy Experience goes live this summer.

Correcting nasal complexity

In this case study, the patient did not like her nose but was unable to provide clear reasoning on what exactly she disliked. She presented with a dorsal bump that was more dominant on her left side; this created a differently shaped nose in certain light. Flattening of the tip of the nose was also present and caused a very slight curvature alongside the previously detailed complexity.

Dr Tim sought to simplify and straighten up the lines of the nose with dermal filler treatment, but, unfortunately, there was an artery exactly where he did not want it and he had to switch technique to accommodate. This is a valuable lesson, learning how to pivot your injection approach to maintain the goal when you know a blood vessel is in the way.

Embarking on the treatment, his first step was to use an ultrasound device to scan for vessels in the nose, determining location and depth before proceeding with any injections. Dr Tim is a fan of this useful tool, read up on Should I buy an ultrasound scanner for my aesthetic clinic?

On placement of his needle at the dorsal hump, he reported a subtle and slight inward curve which was responsible for the nose appearing less straight from certain angles. He aligned his injection approach choosing the most efficient place to hide the small bump, aspirated, and compressed the arteries that posed a risk to the eyes, ensuring that he injected small quantities of dermal filler which would not be significant enough to block a vessel were there to be unidentified intravascular placement, despite his prior safety checks.

Having straightened the alignment of the nose by treating the complexity at the dorsum, Dr Tim moved on to blending the lower tip of the nose which was flattened somewhat.

As before, the first step involved a check with the ultrasound where he located the dorsal nasal artery running precisely where he initially intended to inject. This discovery led Dr Tim to consider an alternative and safer approach using a cannula in the midline at a 90° angle to the artery to avoid the chance of vascular compromise. After creating an entry point and noting the lack of blood (which was good), he ensured that the cannula was mobile within the tissue, aspirated, and deposited a small volume of filler, checking that no blanching occurred. Dr Tim did highlight one downside with this entry point, stating that if there is swelling post-procedure, it will look like the nose is more curved than it is, and the patient should be briefed.

Moving further down, Dr Tim explained that the straightness of the nose is interrupted by a very slight flat point at the tip, choosing to place a tiny amount of product (using the same entry point for his cannula, adding a slight curve to the cannula barrel, and using a downward approach) to correct further. However, he was mindful of checking for adequate space within the tissue for this placement to avoid compressing capillaries which can cause persistent redness at the nasal tip.

Read up on non-surgical rhinoplasty complications include a red nose tip that could be pressure necrosis.

Completing the treatment, Dr Tim and the patient were both very pleased with the immediate straightness of her nose; she enthused

“I’ve hated my nose for so many years, but look at my nose (now), I can’t believe it, it’s made a massive difference but is really subtle”.

Get further insight on non-surgical rhinoplasty treatments in these additional blogs from Dr Tim Pearce.

• How to safely perform a non-surgical rhinoplasty or liquid nose job
• Non-surgical rhinoplasty: liquid nose job injection safety advice
• Liquid rhinoplasty: how to safely inject a previously broken nose
• Non-surgical rhinoplasty: do not inject this type of nose!
• Spotting septum necrosis, severe non-surgical rhinoplasty complication

If you have any tips to share, case studies to discuss, or questions about treating the nose, , you can also find Dr Tim Pearce on Instagram.

Anatomy360 - The Ultimate 3D Anatomy Course

Understanding facial anatomy is crucial for precise filler placement and achieving natural, balanced results. Knowledge of anatomical structures and vascular supply not only helps in avoiding complications but also enhances the overall effectiveness of treatments.

Dr Tim Pearce's anatomy course delivers a thorough understanding of facial anatomy through 12 online lessons. Tim says:

“The problem is we’re taught anatomy in 2D textbooks, but real-life anatomy isn’t flat. In order to feel confident with injecting and to get that millimetre by millimetre precision that increases safety, we need more detail. That’s why I’ve created the ultimate Anatomy learning experience specifically for aesthetic injectors. It’s going to help you up-level your anatomy knowledge and boost your injection safety & confidence in a way that no cadaver course could ever.”

Anatomy360 Course

Aesthetics Mastery Show

Safely Fixing Nose Asymmetry and a Dorsal Hump: Expert Injector Techniques

Dr Tim says:

“In this video, we tackle a complex nasal correction case. The patient was concerned about her dorsal hump, asymmetrical shape, and a nose curvature that appeared differently in various lighting. Learn how to achieve a straighter, more balanced nose while navigating the presence of a crucial artery, which required switching techniques. Discover how to still get great results even when vessels get in the way.”

Watch the full Aesthetics Mastery Show here.

This episode has received many comments already including feedback from clients/patients as well as practitioners, including:

@PeterDaniels-o4l

“A master piece…well done doc…but I’m not surprised. Hands of gold!”

@lusenluck1930

“Thank you so much Dr. Tim to share this technique briefly to us, i myself never did this kind of injection technique cause all my patients are asian nose”

@mohammedmansoor9186

“Super job”

@tracymullane8818

“She’s so happy! That’s great.”

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Dermal Filler eLearning Courses

If you want to increase your knowledge about safe and effective dermal filler injectable treatments, Dr Tim Pearce offers a series of fabulous courses. The foundation level is a popular starting point, with many delegates continuing to complications courses focused around safety, including how to minimise the risk and how to handle things if the worst occurs:

• Dermal Fillers Foundation Course
• Dermal Filler Complications Mastery

Both give CPD and certificates on completion and are highly rated by our delegates.

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.