NON-SURGICAL NOSE JOB (NON-SURGICAL RHINOPLASTY)
Often called a liquid nose job, five minute nose job, fifteen minute nose job, injectable nose job, or no surgery nose job, a non-surgical nose job or non-surgical rhinoplasty describes the use of injectable soft tissue fillers, like Restylane and Juvederm, to camouflage minor nasal deficiencies or correct small asymmetries of the underlying nasal anatomy.
Ideal Patient- Ideal patients for a non-surgical nose job generally fall into two categories: 1) those who have had a previous rhinoplasty and have a residual depression or asymmetry, and 2) those who have a small dorsal hump, low-set nasal bridge, asymmetry of the sides of the nose, or a somewhat shapeless nasal tip and do not wish to undergo a surgical rhinoplasty (click here to learn about Rhinoplasty). By nature of the procedure, injectable rhinoplasty is able to provide augmentation (i.e. addition of volume) of underlying structures, however, a non-surgical nose job is unable to address a twisted nose, bulbous tip, large dorsal bump, or breathing problems. Ideal patients also must have realistic, modest expectations and understand that just like fillers used on the face, fillers used for the nose are not permanent and generally last four to twelve months.
Technique- Prior to doing a non-surgical nose job, I perform nerve blocks to numb the entire nose, then I clean the area to be addressed in order to provide a sterile environment. I use very small needles and inject tiny amounts of filler at a time to ensure exact placement and the appropriate amount of correction without compromising the overlying skin or causing visible lumps or ridges. The areas I find that are best addressed by a liquid rhinoplasty are a low-set nasal bridge that can easily be built up with a small amount of filler. Additionally, the appearance of a small dorsal hump can be softened by injecting filler just above and below the bump, thereby creating a straight, smooth dorsum. The sides of the nose can also be augmented in patients with minor asymmetries or divots. Because of the risk of damaging the blood supply to the overlying skin, I tend to avoid injecting fillers into the tip of the nose except in very select cases. These patients have usually had one, two, or even three previous rhinoplasties and present with retracted skin or visible underlying cartilage following their previous surgeries.
Type of Filler- I prefer to use Restylane when injecting into the nose because it is easy to inject, able to be molded after injection, can be dissolved with hyaluronidase if injected inappropriately, is not permanent, and to date, there are no reported cases of patients developing allergic reactions or foreign body granulomas (i.e. large balls of scar tissue) following injection of Restylane into the nose. I avoid the use of long-lasting fillers like Radiesse and Artefill when performing a no surgery nose job because these fillers tend to cause more scar formation and can become hard and calcified, which may cause a problem for patients who later decide to undergo a formal, surgical rhinoplasty. Additionally, these fillers cannot be dissolved with hyaluronidase if injected improperly.
Recovery- The beauty of the liquid rhinoplasty lies in the recovery. Because there is no surgery involved, side effects such as bruising and swelling are usually limited to a few days. Following any injectable procedure, I ask that all my patients apply ice to the area for several hours and avoid strenuous exercise for a few days.
Risks- The immediate risks of a no surgery nose job are usually limited to bleeding and infection. To avoid these complications, I perform all injections under sterile conditions and insist that all of my patients be off prescription, over the counter, and herbal blood thinners (e.g. aspirin, garlic, etc…) for at least two weeks prior to the procedure. Skin irregularities and bumps can also be noticed after injection, particularly in very thin-skinned patients. If this occurs, these irregularities can usually be managed with early and aggressive massage, and rarely, an enzyme, hyaluronidase, can be injected to dissolve the aberrant filler. There are also reports of filler being injected directly into the arteries surrounding the nose or under high pressure into the nose thus causing skin damage and necrosis. To avoid such complications, I inject very small amounts of filler with a tiny needle under low pressure. Because there are currently no long-term studies investigating the late effects of soft tissue filler augmentation of the nose, the long-term risks are largely unknown. However, potential long-term complications could include chronic infection, granuloma (i.e. excess scar) formation, and skin retraction and calcification of soft tissues secondary to injection of permanent fillers.
In summary, the non-surgical rhinoplasty is becoming an accepted addition to the armamentarium of tools that rhinoplasty surgeons have available to them when addressing the nose. While the applications are somewhat limited, selected patients may be able to avoid surgery or temporarily conceal imperfections with the use of these soft tissue fillers. As with a traditional surgical rhinoplasty, I recommend that patients interested in a non-surgical rhinoplasty seek treatment only by a board-certified plastic surgeon that is comfortable with nasal anatomy and aesthetics, experienced in surgical rhinoplasty, and up-to-date on the latest techniques and practices.
Jaime Perez, M.D.