By Dr. Marco Romeo — Specialist in Plastic, Aesthetic and Reconstructive Surgery. Member of the Spanish Society of Plastic, Reconstructive and Aesthetic Surgery (SECPRE).
I have recently had the opportunity to collaborate with leading media outlets such as OKDiario, El Economista and bellezaMÉDICA to raise awareness about a phenomenon that deeply concerns me as a surgeon: the trivialisation of non-surgical nasal aesthetic procedures, particularly rhinomodelling with hyaluronic acid.
Under headlines such as “The Dark Side of Rhinomodelling” and warnings about severe vascular complications, we have addressed a reality that many patients are unaware of when seeking quick, low-cost treatments: the nose is an extremely complex and highly vascularised anatomical structure, where a single mistake can have irreversible consequences.
Why anatomy changes everything
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The concept I most insist on conveying, both in consultations and through the media, is that of nasal vascular anatomy. The nose is not simply skin and cartilage: it is supplied by a network of very fine-calibre arteries with anastomoses (connections) between systems, meaning that a poorly placed injection can affect areas far from the entry point.
The most critical structures are the angular artery and its lateral and dorsal nasal branches, which form part of the facial artery system. Unlike other areas of the face, the nasal vessels have very little protective fatty tissue and run extremely close to the surface. This makes any nasal filler procedure one of high vascular risk, regardless of the product used.
As I explained in El Economista, the most tragic aspect of serious rhinomodelling complications is that, in the vast majority of cases, they are entirely preventable. A tiny error — a millimetre difference in injection depth — cannot only produce a poor aesthetic result: it can interrupt blood flow and cause tissue necrosis (death of nasal tissue) and, in cases documented in the international medical literature, even vision loss due to ophthalmic artery occlusion.
What Exactly Is Necrosis from Rhinomodelling and How Does It Occur?
As I have detailed in OKDiario, El Economista and bellezaMÉDICA, there are three main mechanisms by which a nasal filler can trigger necrosis:
- Direct intravascular occlusion: The filler material — usually hyaluronic acid — is accidentally injected directly into the lumen of an artery, blocking it immediately.
- External vascular compression: An excessive volume of product compresses the arterial wall from the outside, progressively reducing blood flow until it is completely cut off.
- Cumulative re-injection effect: Successive sessions that gradually saturate the tissue, hardening it and chronically compromising the microcirculation, even when no individual injection has been intravascular.
In all three cases the outcome is the same: the skin of the nose is left without a blood supply. If no action is taken within the first few hours, the tissue dies irreversibly.
Highest-Risk Procedures and Warning Signs You Must Not Ignore
The non-surgical treatments most frequently associated with documented nasal vascular complications are:
- Poorly applied hyaluronic acid fillers: The primary risk factor. The problem lies not in the product itself, but in the lack of anatomical training of the person administering it.
- Nasal thread lifts: Particularly dangerous when placed at the tip or dorsum, where vessels are most superficial and of the smallest calibre.
- Re-injections without a safety interval: Accumulation of product in tissue already compromised by previous sessions, multiplying the risk of ischaemia.
- Skin colour changes on the nose (sudden pallor, grey or purple tones)
- Intense, disproportionate pain relative to the procedure performed
- A sensation of cold, numbness or progressive loss of sensitivity
- The appearance of dark spots or areas of skin that look “dead”
- Any visual disturbances whatsoever (blurred vision, loss of visual field)
Time is tissue. Every hour without treatment drastically reduces the chances of full recovery.
My 3 Non-Negotiable Recommendations Before Undergoing Rhinomodelling
If you are considering rhinomodelling, my professional advice is strict and admits no exceptions:
- Avoid “low cost” offers: Biological safety has a real price. A suspiciously low fee usually implies questionable-quality products, clinics without emergency equipment, or practitioners without the necessary training. In medicine, cutting costs can prove very costly indeed.
- Demand a practitioner with genuine surgical training: Only a professional who knows the internal anatomy of the nose — not merely its surface — will know where not to inject. You need someone capable of mentally “visualising” the angular artery beneath your skin while they work.
- Ask about the safety protocol before you sit down: Your doctor must have hyaluronidase (the enzymatic antidote for hyaluronic acid) available in the clinic at all times, before the procedure begins. If they do not have it, or do not know what you are talking about: stand up and leave.
Frequently Asked Questions About Rhinomodelling Risks
Is rhinomodelling more dangerous than surgical rhinoplasty?
Although rhinomodelling is not surgery, it carries specific vascular risks that conventional rhinoplasty does not. Rhinoplasty is invasive but performed under direct vision: the surgeon sees exactly what they are touching. Rhinomodelling, on the other hand, is performed “blind”, without seeing the vessels. Paradoxically, therefore, it can be more dangerous in inexperienced hands. It is essential that it be performed by someone with genuine surgical training and experience in nasal anatomy.
Can necrosis be reversed if detected in time?
If the complication is detected within the first few hours, effective treatment is available. We administer hyaluronidase immediately to dissolve the filler and restore blood flow, alongside vasodilatory medication. The prognosis depends directly on the speed of intervention: every hour counts. If diagnosis is delayed, tissue damage may be permanent and require complex reconstructive procedures. Always remember: time is tissue.
How long does hyaluronic acid last in the nose?
Nasal hyaluronic acid has a variable duration, typically between 9 and 18 months depending on the type of product and the patient’s metabolism. However, the problem is that repeated re-injections progressively accumulate product in a tissue with limited circulation, steadily increasing the risk of vascular complications. There is no such thing as a “risk-free” rhinomodelling procedure simply because someone has been having it done for a long time.
What is the difference between ultrasonic rhinoplasty and rhinomodelling?
They are radically different procedures. Rhinomodelling adds volume using injectable fillers without surgery; it is reversible but carries the vascular risks described above. Ultrasonic rhinoplasty is real surgery, performed with piezoelectric ultrasound instrumentation that allows the nasal bone to be reshaped with unparalleled precision and respect for soft tissues, with virtually no bruising. It is the safest option with permanent results for those seeking a genuine change to the nasal structure.
Do You Put Your Safety Above Everything Else?
Aesthetic medicine should not be a game of chance. If you are looking for a natural result without compromising your health, I will study your anatomy in detail to offer you the safest option.
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