Why So Many Experts Refuse To Perform This Beauty Procedure

If social media is anything to go by, non-surgical nose jobs are more in demand than ever before. Otherwise known as liquid rhinoplasty, aestheticians and beauty enthusiasts tout it as a pretty standard procedure, taking as little as 15 minutes to temporarily alter the shape of the nose. Right now, it's difficult to scroll through certain social apps without coming across countless viral videos and before-and-after pictures documenting the results.

The procedure is especially popular on TikTok, where the hashtag #nonsurgicalnosejob has 16.4 million views and counting as Gen Z in particular raves about the instantaneous results. TikTokers show their followers firsthand just how easy, painless and 'affordable' (compared to rhinoplasty surgery) the procedure is. But while the 'tweakment' (which can start at £300 in the UK) continues to surge in popularity, the risks and possible long-term consequences associated with non-surgical nose jobs are often ignored entirely – though many of them are dangerous and potentially life-changing.

"Non-surgical rhinoplasty (NSR) involves using dermal fillers to augment the shape of the nose without the need for surgery," explains Dr Dianni Dai, resident doctor at Rejuv Lab London. Unlike surgical rhinoplasty, no bone or cartilage is removed to reshape the area. Hyaluronic acid filler is used instead to add volume, mimicking the effects of a nose job. This is said to improve symmetry, smooth out bumps or fill out gaps in the bone. Dr Preema Vig, medical director of the Dr Preema London Aesthetic Clinic, says that after a consultation to determine where the filler will be placed, it is then strategically injected into the nose. "The most common areas to inject are around dorsal humps (the nose bridge) to camouflage, or into the tip of the nose to raise the nose tip," she adds.

The rise of non-surgical rhinoplasty comes as a knock-on effect of the past year, the pandemic and the endless Zoom calls. Dubbed 'Zoom face', we’ve stared at our non-filtered appearances more than ever, and lockdown has created a demand for quick-fix non-surgical treatments to enhance our features or alter any gripes, whether that's our lips, noses, wrinkles or cheeks. "There’s been a huge interest in noses generally, both surgical and non-surgical procedures, which are a result of the Zoom effect," agrees Mr Naveen Cavale, a plastic and reconstructive surgeon. According to the 2020 British Association of Aesthetic Plastic Surgeons (BAAPS) audit, last year saw a 20% decline in surgical rhinoplasty, which they attribute to the rise in popularity of fillers and non-surgical nose jobs. 

Recently, aestheticians and doctors have taken to social platforms to express their concern regarding the misleading information around liquid rhinoplasty and videos posted by those who have undergone the procedure which fail to show the full story. Many tout these nose jobs as 'magical' but there is a risk of things going very wrong. There have been reports of filler getting into the blood vessels, as TikToker and beauty doctor Sarmela Sunder has warned, which can cause severe complications down the line. These may include necrosis (death of the skin tissue, which cannot then be salvaged and must be removed), cysts and infections. Dr Shereene Idriss, a board certified dermatologist and cosmetic expert, elaborates on the danger. "The nose is a high risk site for vascular blockage," she says. "It is a closed compartment with end arteries, meaning blood flows to the nose with no collateral circulation. If the blood supply gets blocked off through the use of injectable fillers, the surrounding tissue has no backup reserve to receive oxygenated blood and when left untreated, is left to rot." 

That's just the tip of the iceberg, as the anatomy of the nose is complex to say the least. Given that it is highly packed with blood vessels and has an anatomically complex structure, explains Dr Dai, it requires very delicate handling. In fact, some cosmetic experts and dermatologists trained in filler refuse to offer the procedure altogether. "Liquid nose jobs are not to be taken lightly as they are one of the highest risk cosmetic procedures involving fillers," warns Dr Idriss, adding that blindness is a risk. The highest reported cases of blindness from filler occur when it is injected into the nose, she says.

Dr Emily MacGregor, founder of STORY clinic, seconds this. "Blood vessels that don’t connect up to others (like a road that's a dead end) and ones that connect up to the blood vessels supplying the eye are the ones most at risk of causing problems, and unfortunately, the nose has many of these." She continues: "If small amounts of filler are placed in exactly the right place and right depth (and rather terrifyingly, the margin of error is about a millimetre) then this risk can be significantly reduced, but not eliminated."

Having this treatment done by an expert professional is crucial. The right choice of filler is vital, too. Radiesse, for example, which contains calcium hydroxyapatite, is thought to be unfit, according to reports. A recent study published in JAMA Ophthalmology cited the case of a woman in her 40s who, after getting liquid rhinoplasty with Radiesse, felt acute left eye pain which developed into sudden loss of vision post-treatment. Unfortunately, this isn't an isolated incident: a review published in Dermatologic Surgery in 2015 identified several cases of irreversible vision damage caused by filler.

Another serious cause for concern is the lack of control and supervision of filler in the UK. "Fillers are less regulated here compared to other European countries," explains Dr Dai. "As fillers are technically not a prescription-only medicine in the UK, practitioners who are not medically qualified can also legally inject [it]." Dr Dai says that this poses significant safety risks as medically unqualified practitioners (who are not trained in the anatomy of the nose and dermal fillers) are carrying out the procedures. Mr Cavale adds that since filler is classified as a 'medical device' – as opposed to a drug – it can be acquired and therefore injected by anyone. So not only can nose filler be injected by untrained professionals but they are unlikely to be equipped to deal with any complications as they lack the training and medical knowledge on blood vessels and anatomy.

According to Dr Idriss, there are other long-term aesthetic risks to be aware of, too. "Other than the safety risk which gets amplified with each subsequent treatment due to previous trauma and residual filler left behind, there is also an aesthetic risk that is most often overlooked," she warns. "Although the contours of the nose itself can appear to be dramatically improved post-treatment, the overall proportions of the nose over time get enlarged with each subsequent treatment," she says. "Unlike the fillers being injected under facial muscles in order to lift volume, and in the process being broken down and metabolised due to repetitive nature of facial muscle movement, fillers in the nose have the propensity to remain stagnant longer over time due to the lack of inherent movement of the nose." As she points out, with subsequent treatments patients might gradually experience 'filler diffusion', which can enlarge and widen the nasal bridge. This may reverse the intended aesthetic purpose.

Claims of longevity and 'miracle' results surfacing on TikTok also fail to mention that you need regular upkeep and several dermal fillers following the procedure. Dr MacGregor says that because this treatment needs repeating every one to two years (more regularly in some cases), if someone is sure that they want to change their nose shape permanently, she would encourage them to have a consultation for surgical rhinoplasty instead. "In my opinion, a liquid nose job should not be considered a trivial treatment or a cheap alternative to surgery; it is at its best when it is used to help someone decide whether later down the line a surgical nose job to correct a dorsal hump (a bump on profile) is right for them."

Besides the countless safety risks involved in the procedure itself, there’s the risk of psychological damage to consider, too. While this type of treatment has long been popular in the aesthetic industry, its prevalence on social media (and especially exposing younger generations to this kind of content) is new. "What is concerning about these widely available videos of non-surgical rhinoplasty on TikTok is the universal perception of a 'perfect' nose and the individual characteristics of one's nose are largely overlooked," says Dr Dai, who emphasises that individual facial features are unique and that presenting a one-size-fits-all nose job online is by no means healthy. 

A quick search of the latest liquid nose jobs on social apps shows that 'magical nose jobs' or 'quick fixes' are everywhere. One video posted on TikTok exclaims: "Why are you contouring with makeup? When you can get a nonsurgical nose job!!!" As the conversation about tweakments opens up and gradually chips away at the stigma surrounding them, there is no denying the potential impact of this increased exposure on Gen-Zers scrolling their feeds on the hour. Dr Idriss explains that the procedure is made to appear "too easy" on social media, where videos can be edited and put together succinctly, erasing any difficulties. "It overlooks all of the potential complications, therefore encouraging patients to jump on board without evaluating the risks or the credentials of the person doing the treatment,” she says.

Before considering this kind of treatment, the most important thing is to do your research. Knowing about your practitioner’s specific experience, the possible risks and the procedure itself is paramount. "My advice would be to only get a non-surgical rhinoplasty by a medical doctor or nurse," advises Mr Cavale. "You can see if a doctor is registered on the General Medical Council’s website or if it’s a nurse, the Nursing & Midwifery Council. And if they’re not, it’s a big red flag," he adds.

Always look for Care Quality Commission (CQC) regulated clinics, too, which have higher safety protocols, Mr Cavale emphasises. Also, if the price looks too good to be true, it probably is. Dr Idriss agrees: "Do your homework and go to a physician with the right credentials who is not only board certified but board certified in one of the four core cosmetic specialties: dermatology, plastic surgery, otolaryngology/ENT/facial plastic surgery and ophthalmology/oculoplastic surgery." 

Dr MacGregor points out that only 1-2% of doctors and nurses injecting filler in the UK have sat any exams to prove their expertise. "To contextualise the liquid nose job, we don't even teach this treatment to our students [at Harley Academy] because it is considered too high risk for even the best practitioners to attempt in their first year of injecting." She adds: "To see beauty professionals unknowingly sticking needles in high risk areas of the nose on social media is so shocking to me." Dr Dai adds: "It’s important that whoever performs the injection should have a medical background and a comprehensive understanding of the nose anatomy; the injector should be an expert in dermal fillers so an appropriate choice of filler can be made for optimal results."

Whether or not you are thinking about undergoing this procedure, the takeaway here is not to fall victim to the compelling videos infiltrating your social media feeds. Look to expert advice to determine the best route for you. Discuss expectations, understand the risks and only consider this kind of treatment in the hands of an experienced and specialised medical expert.