Dissolving vs removing fillers in the nose prior to rhinoplasty

For many patients unhappy with their nose, the first step may be a noninvasive treatment, such as fillers. Dermal fillers can provide short-term results that may improve the appearance of the nose for the right type of patient, but for most, this method falls short. In these cases, rhinoplasty is recommended.

Many patients may have already tried fillers for their nose and are unsure if this affects or impacts their candidacy for rhinoplasty. The good news is that rhinoplasty procedures are largely unaffected by fillers, as they can be easily removed or dissolved both prior to and during the procedure.

How does this process work, and what is the best method of doing so? Do any of these methods affect the result of a rhinoplasty? To gather more insights into the topic of how to best remove fillers before rhinoplasty, we reached out to ASPS Member Surgeon Richard Reish, MD, FACS.

The popularity of fillers in the nose

While this issue may feel rare or uncommon, the truth is that it might just be more popular than you'd think.

"This is extremely common for patients, first of all, to get filler in their nose and then go on to have rhinoplasty surgery afterwards," said Dr. Reish. "One issue with this is that, unfortunately, a lot of patients just are not good candidates for nonsurgical rhinoplasty (fillers in the nose). A lot of these patients who do have fillers will realize that it was not a good decision and will then go out to seek surgical care for their nose."

While some providers and social media personalities may push the narrative that you need to wait to have rhinoplasty following fillers in the nose, the truth is much less harsh.

"Sometimes, what I find is that some patients are just getting the wrong advice," said Dr. Reish. "I have had patients come into my office who say that they have heard that if they get filler in their nose, they cannot get rhinoplasty for one to two years. This may be because some providers are confusing revision rhinoplasty timing with filler timing, as we will sometimes say you have to wait a year or two after your last surgery to get a revision rhinoplasty. You can technically get a rhinoplasty any time following filler."

How to remove fillers in the nose prior to rhinoplasty

Like many procedures, the methods surgeons use to remove fillers from the nose vary. Some surgeons prefer to do so prior to the procedure, while others perform the removal in tandem. This can differ based on the individual needs of the patient as well.

Surgeons who remove fillers before surgery will have a clearer perspective on the true structure of the nose and what can be accomplished with the rhinoplasty.

"In this situation, what a lot of providers will tell patients is that they need to have the filler dissolved prior to surgery," said Dr. Reish. "There is technically nothing wrong with this advice. A lot of good surgeons will say that they should get it dissolved prior to the consultation, with some preferring some several months in advance to reduce swelling."

Yet, many surgeons prefer to pair filler removal with the actual rhinoplasty.

"I am very comfortable telling patients to go straight into surgery with the filler in their nose," said Dr. Reish. "When you open up the nose, the filler is typically just sitting there, and it will come right out. It is very simple and easy to manage as an experienced rhinoplasty surgeon. I will open the nose, take the filler straight out and it will come right out as a clear, gel-like fluid. Some other fillers, such as Sculptra or silicone filler, can be a bit more challenging to remove due to scar tissue surrounding them. But we are still very capable of taking them out."

One issue to remain cognizant of when considering dissolving fillers in the nose prior to surgery is the risk of damage.

"The reason that I really do not love dissolving prior to surgery, particularly hyaluronic acid fillers, is because the (dissolving) enzyme can cause damage to the surrounding tissues," said Dr. Reish. "A lot of surgeons will flood the area with the enzyme to dissolve the filler, and this does a great job of dissolving the filler, but it can cause damage to the surrounding tissues."

Another type of filler that can prove difficult to remove, both prior to and during surgery, is one that is silicone-based.

"Silicone injections can be challenging to remove, but it is very possible to take out that scar tissue and granulomas that occur during rhinoplasty surgery," said Dr. Reish.

Another point to consider is the recent trend of polydioxanone (PDO) threads for the nose. This may be a hot topic on social media and promise amazing results, but it can cause lasting damage.

"The infinitely worse scenario is PDO threads in the nose," said Dr. Reish. "They don't work, they don't last, they cause a massive amount of scar tissue and there is no enzyme that can be injected prior to surgery to remove. The surgeon has to go in and remove all of the scar tissue that goes with the threads. Taking out a PDO thread in a patient is like a bomb went off in the nose, and there is just scar tissue everywhere."

Rhinoplasty is the natural next step for patients who have tried fillers to correct the appearance of their nose and are unhappy with the result. Consult with a board-certified plastic surgeon to explore your options. Some misinformation online may lead patients to believe that fillers cancel out their candidacy for rhinoplasty, but fillers can be easily removed or dissolved both prior to and during the procedure with little to no effect on the overall results. The timing, means and methods of doing so vary between surgeons, but they do offer the same end result – a more aesthetically pleasing nose that is free of fillers.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.