Non Surgical Nose Job – Fact vs. Fiction

by

Alexander Rivkin, M.D.

In the four years since its introduction, the procedure of Non Surgical Rhinoplasty (Non Surgical Nose Job) has been embraced by both physicians and patients as a useful alternative to surgical rhinoplasty. The simplicity and ease of the procedure has brought in patients who were too scared or couldn’t afford surgery. Patients whose work schedules do not permit the downtime of surgical rhinoplasty appreciated the ability to correct the bump or deviation or droopy tip with an in-office injection procedure. Asian and black patients appreciated the ability to raise and define the bridge of their nose and de-emphasize a round tip, all without a major operation that, all too often, resulted in an unnatural appearance. Patients who had undergone several rhinoplasty operations to revise an unsatisfactory surgical result without success took advantage of this option to correct the lingering imperfection without going under the knife again.

This procedure is not for everyone. There is no way of actually reducing the size of a large nose without surgery. However, it is interesting to note that, just by camouflaging a bump or making a crooked nose straight, the patient’s nose will appear smaller. It is a bit of an optical illusion, but a feature that is regular and blends in with the rest of the face is less noticeable and appears smaller than a feature that is not in harmony, is asymmetric or bumpy. The Non Surgical Nose Job procedure is purely cosmetic. It will not improve breathing and cannot correct a deviated nasal septum.

The Non Surgical Rhinoplasty procedure can be performed using a variety of fillers. I have always used calcium hydroxyapatite (Radiesse). It lasts a good amount of time (about 10 months) and holds its shape well. Small amounts of Radiesse are injected deep beneath the skin, so the aesthetic effect is natural and smooth. It is important to always inject as little as possible – the doctor can always bring the patient back for a touch up. Overfilling the nose, even by a little bit, looks terrible.

Radiesse is a very safe filler. Long term complications are unheard of and I have never seen a patient be allergic to the material. The most common complaint is that the effect doesn’t last long enough. This is not to say that side effects do not happen. The skin of the nose can be quite thin in some areas, especially after surgery. Overinjection of an area like that can cause damage to the skin, infection and even skin sloughing. This is why good training is essential to the safe and effective performance of the Non Surgical Nose Job. A variety of doctors are performing the procedure today and the informed consumer needs to be sure that the doctor they choose is well trained in injectables and trained specifically in this particular procedure.

Some of the rhinoplasty surgeons around the country have criticized the procedure as leading to complications such as bumpiness, poor aesthetic effect and nasal skin damage. They are absolutely correct. However it is the injector and not the procedure that they should be focusing on. If properly performed, the procedure is great. The issue is that there is no oversight over who can and cannot perform this procedure. I think that any problems that are being seen are most likely due to injector error.

Another criticism of this procedure is that it is a temporary measure. This was true when the only filler available was Radiesse. Last year, however, Artefill was approved by the FDA. Artefill is the first permanent filler available in the US. Artefill is sometimes used in patients who have a good result with Radiesse but want a permanent effect. Although it takes several sessions to build up the Artefill in the nose so that the effect is permanent, satisfaction rates so far have been excellent. Artefill should only be used in patients who have been shown to be non allergic via a skin test. Patients should also know that, once they get Artefill injections, they really should never have rhinoplasty surgery. Artefill stays in the skin for years, so performing surgical procedures on skin that has been injected with Artefill is much more complicated and difficult.

Needless to say, Non Surgical Rhinoplasty using Artefill should only be performed by physicians who are experts in the procedure. Artefill cannot be removed and it never goes away, so surgical excision is the only way to correct a mistake. In general, physicians who are not that experienced in the technique should be using one of the hyaluronic acid products – Restylane or Juvederm. These injectables last a good amount of time – about 6 to 8 months – and are easily dissolved with an enzyme if the effect is not as expected.

In summary, the Non Surgical Nose Job procedure has proven itself to be an excellent alternative to surgical rhinoplasty for certain patients. It is safe, effective, affordable, painless (relative to surgery) and involves minimal downtime. However, patients must choose their physician with care. The procedure has its pitfalls and the doctor must be well trained and experienced.

Alexander Rivkin M.D. is a Yale trained facial cosmetic surgeon and UCLA faculty member who has focused his practice exclusively on providing his patients with the latest in non-invasive cosmetic treatments. He has made his name in developing non-surgical alternatives to commonly performed cosmetic procedures. Dr. Rivkin divides his time between patient care, clinical research, educating other physicians, media appearances, and lecturing at scientific conferences throughout the world.

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