A dorsal hump refers to an unwanted bump on the nasal bridge. Fillers can be used to hide the bump by creating a better transition between the bump and the area above and below it. Reshaping the nasal bridge in this way makes the contour of the nose look smoother and straighter, particularly when viewed from the side.

Contour irregularities to both the bridge and nasal tip can distort the nose resulting in a crooked, indented and asymmetrical form. Fillers can be used to straighten and smoothen the nasal contours for a more aesthetically pleasing profile.

A bulbous or amorphous tip occurs when the nasal tip is too round or too wide and lacks definition. Careful injection of fillers at the tip and surrounding structures can be used to provide more definition and a slight narrowing of the tip (non-surgical tip plasty). There are, however, limitations to how much correction can be achieved with fillers and surgery is preferable for patients with a large bulbous tip as the cartilage support can be refined and reconfigured using various suturing and grafting techniques.  Nevertheless, fillers can be an excellent choice for patients with a mild to moderately rounded tip who need more definition and some degree of narrowing.

A poorly supported nasal tip can result in tip descent or droop (ptosis), thereby reducing the angle between the tip and the upper lip (nasolabial angle). This angle is an important consideration in determining the aesthetics of a nose and is ideally 95-100 degrees in a female and 95-100 degrees in a male. Deviations from this as a result of tip droop (or indeed an excessively upturned nasal tip) can result in a less aesthetically pleasing side profile. A dropped tip with an under-projected upper nasal bridge can also create the illusion of a large bump or curvature of the nose (pseudo-hump).

Nose fillers can be used to provide better tip support both through direct injections to the nasal tip and indirectly through injections to the nasal bride. The tip can be rotated upward through a cantilever technique by augmenting the nasal bridge and the supra-tip region just above the peak point of the tip, which can be further supported by injections to the columella and alae (the middle vertical bridge and sidewalls of the nostrils). Augmenting the upper nasal bridge near the junction with the forehead (radix augmentation) can be particularly beneficial in patients with a pseudo-hump who have a particular deficiency in this area. 

While counterintuitive, smoothening, straightening and lifting a crooked nose or a nose with a significant dorsal hump by adding volume with nose fillers creates the illusion that the nose is smaller and more harmonious with the rest of the face.

Generally, surgical rhinoplasty is a procedure with good outcomes. However, even after a successful rhinoplasty, there may be small contour irregularities that can be improved with fillers as a revisional non-surgical procedure. This is particularly beneficial when the irregularity is too minor to warrant revisional surgery or if a patient would like to avoid further surgery. On the other hand, some patients can experience significant structural and hence contour deficiencies as a complication following a surgical rhinoplasty. For example, excessive cartilage removal during surgery can lead to a partial collapse of the nasal bridge leading a saddle deformity (saddle-shaped concavity or depression). Similarly, excessive disruption of the cartilaginous support of the nasal tip can weaken the structure and lead to a tip drop.

Depending on the specific nature and severity of the deformity, quite substantial corrections can be made with fillers without having to resort to more surgery.

For example, the projection of the nasal bridge can be restored in a patient with a moderate saddle deformity using specific filler types. Tip support can be enhanced by treating both the tip and nasal bridge with fillers.

HA fillers in non-surgical rhinoplasty provide a highly versatile method to achieve delicate, very specific refinements in the appearance of the nose with a level of precision that may not be possible with nose surgery. Non-surgical rhinoplasty is an easily reversible procedure. In contrast, it is significantly more difficult and often impossible to correct or reverse changes that were made following a surgical rhinoplasty. Furthermore, minor adjustments can be performed to a nose treated non-surgically with HA fillers if necessary at the review consultation very soon after the initial procedure. In comparison, it is usually recommended to wait a minimum of 12 months or more before undergoing revisional surgery to correct problems after a previous operation.

As non-surgical rhinoplasty is a minimally invasive technique, there is potentially a significantly less overall risk of complications and significantly less downtime than compared to surgery when performed by trained specialists. Patients can return to work or their usual routine immediately or very soon after treatment. Patients who have had a surgical rhinoplasty, on the other hand, often have a downtime period of 1-2 weeks due to bruising, swelling and discomfort. In addition, a degree of swelling of the nose that may persist for several months to years following surgery.

A non-surgical rhinoplasty will need repeat treatments to develop and maintain the results. In contrast, the results of a surgical rhinoplasty are permanent, albeit allowing for the maturation of internal scars and the normal anatomical changes that occur with ageing of the nose. However, with repeat hyaluronic acid filler non-surgical treatments, there is a progressive improvement in the baseline appearance of the nose such that the frequency of repeat treatments decreases significantly with time. Nevertheless, you will need to decide whether you would be prepared to undergo maintenance treatments in the future.

The decision to choose between a non-surgical versus surgical rhinoplasty will depend on several factors. There are limitations to what can be achieved with surgery, and this is also true for non-surgical rhinoplasty. For some patients, surgery is the only real good option if they have severe anatomical problems such as a substantial collapse and deficiency of the structural cartilaginous and bony support mechanism of the nose or a very large bulbous tip. However, even quite significant structural defects can sometimes be cosmetically improved with fillers, and this depends on the severity of the problem and the patient’s expectations.

Patients with irregularities in the structure of their nose may also have functional problems. For example, a crooked or curved nasal bridge may also be associated with a deviated septum (the inner wall separating the right and left nasal cavities), which in turn can cause problems such as nasal congestion, breathing difficulties, and snoring. These patients would be better served by having a septorhinoplasty (combined cosmetic surgery of the nose and correction of the septum) rather than a non-surgical procedure. Surgery can address not only cosmetic concerns of the nose but also functional problems that a non-surgical procedure simply cannot.

While the overall risks associated with a non-surgical rhinoplasty are significantly fewer than with surgery, as with any interventional cosmetic procedure, it is not risk-free. Temporary side effects such as bruising and swelling at the injection site may occur but are self-resolving usually in a matter of a few days. There will be a degree of persistent swelling that may take several weeks to settle. However, this is minor and rarely noticeable to other people.

The risks of complications following a non-surgical rhinoplasty are very low, particularly when compared to surgery. Infection has been reported to occur; however, this is very uncommon, particularly as the nose is prepped and cleaned with a surgical antiseptic solution. Although serious complications have been reported with non-surgical rhinoplasty, the incidences of these are rare to very rare. Notably, there is a risk of vascular occlusion resulting from external compression or embolisation (internal blockage of a blood vessel with a bolus of filler) while injecting or shortly afterwards. Occlusion of blood vessels can lead to vascular compromise with ischaemic injury to the soft tissue resulting in loss of skin and possibly even cartilage due to necrosis (tissue death). The risk of vascular compromise is increased when injecting the nasal tip, columella and alae and therefore particular caution is paramount when treating these areas.

The relative risk of vascular compromise is also increased in patients who have had a previous surgical rhinoplasty due to the scarring and distortion in anatomy that occurs following surgery. It should be noted, however, that the risk of complications is also increased for revisional surgical rhinoplasty for the same reasons. Very rarely, vascular occlusion of the retinal and ophthalmic arteries with fillers has been reported leading to blindness. Despite these potentially serious but very rare risks, non-surgical rhinoplasty remains substantially safer than surgical correction when performed by a skilled and trained specialist.

Although the risk of serious complications is very low, filler treatments must be performed by specialists with extensive clinical expertise and, preferably, surgical anatomical knowledge and experience to ensure these risks are kept to the minimum. Dr Rhobaye is a leading authority in non-surgical and minimally invasive facial aesthetics and highly trained specialist in cosmetic fillers, with extensive background experience in facial surgery. He has a subspecialist interest in non-surgical rhinoplasty and has advised on national committees to develop evidence-based emergency protocols in place to recognise and treat an impending complications.