Non-surgical Rhinoplasty is a recent development in the field of cosmetic surgery which does not use any incisions on the patient’s nose. It is a procedure which allows reshaping the nose without any invasive surgery.
This procedure is recommended for those people who are seeking a minor adjustment to the size or shape of their nose. The procedure is completely safe and is approved by the International Medical Association and U.S Food and Drug Administration (FDA).
Nose job without surgery can be successfully accomplished by using injectable fillers to straighten the nose profile. The surgeon can fill in the depressions or smoothen out the hump on the nose by filling in the adjoining areas.
The most commonly used dermal fillers for nose are Hyaluronic acid and calcium based microsphere filler called Radiesse®.
This procedure is used to correct almost all minor defects in the nose except the ones which require a thorough cartilage harvesting and grafting. Droopy tip, bulbous nostrils, visible humps on the bridge, uneven nostrils, weak nasal structure and any odd shape of the nose can be corrected by non-surgical Rhinoplasty.
This non-surgical approach can neither cure breathing problems not reduce the size of the nose. Since there is no incision and reduction surgery the nasal bone and supporting cartilages remain unaltered. But, it can give the patient an aesthetically attractive nose by filling in the areas which are causing imbalance and asymmetry.
The world has seen advancements in the field of facial plastic surgery where injectable fillers are being used more and more. Patients are also becoming open to the new possibilities of non-surgical treatments and enhancements.
History of Nose Job without Surgery
The early experiments began in the 19th century when two dynamic surgeons, James Corning and Robert Gersuny, started using liquid paraffin wax to create the results which were obtained by a regular Rhinoplasty surgery. These procedures were efficient, result-oriented, fast and had negligible recovery time.
The non-surgical injectable fillers were for first used to elevate the collapsed dorsum which leads to the saddle nose deformity. The fillers were also experimented on other deformities with satisfactory results. But, despite the success of non-surgical fillers, liquid paraffin wax started producing extreme reactions in patients and showed signs of creating biological problems.
In the 60s, silicone gel was implemented in the Rhinoplasty surgery. The surgeons began experimenting with a permanent nose job with these implants. But, like liquid paraffin, this too started causing problems to the patients. Many people reported with ulcers and granulomas (rejection of foreign particles by the body) after their surgery.
After extensive research Dr. Orentreich came up with an alternative technique called “microdroplet technique” where small proportions of injectable silicone was used on the patients over many sessions. But the contents of silicone gel were always objectionable as it caused health problems to many patients over the years.
In 2002, an American surgeon called Dr. Alexander Rivkin started experimenting with injectable fillers like Restylane® and Radiesse®. These were the only agents approved by the FDA for Rhinoplasty during those years. Based on the success gained by this procedure, Dr Rivkin, in 2003, made the method public as “non surgical nose job” through American media. He also used a synonym called “injection Rhinoplasty”.
In 2005, Dr. Andrew Le from Australia reported successful injection nose job by using Polyacrylamide gel (PAAG), a hydrophilic colloid injected in the tissues to correct nasal defect. This is also known by the name “Aquamid®” in the market.
Who can opt for non-surgical nose job?
The surgeon usually recommends whether the patient has to go for a normal surgery or can get the results with non-surgical procedures. However, the final decision is left with the patient and he/she can decide after consulting their family members and other experts in the field of plastic surgery.
Men and women of all age categories can safely use injectable fillers after having a skin test if required. Children below 14 years are advised not to go for such surgeries as their nose is still forming and taking shape. When they grow into an adult they can decide if they want to change their appearance.
Sometimes the financial constraints can also lead to patient opting for a non-surgical nose job instead of a full-fledged permanent surgery. The injectable fillers are temporary and have to be replaced after about a year. But, the inexpensive fillers can be changed without much dent on one’s bank balance.
In some rare cases the surgeon finds that any kind of surgery can lead to further deterioration of the facial muscles and cartilages. They may have been damaged beyond repair and the body is too old to create new tissues. It might have lost the ability to create healthy muscle mass and skin due to some disease. In such cases, the best option is non-surgical nose job. The patient has to follow-up with the surgeon for future fillings as and when required.
People who are not happy with their primary Rhinoplasty can also be asked to go for non-surgical fillings instead of a revision Rhinoplasty. Usually this will correct any minor deviations which were left off during the first nose job. The patient is also relieved that he does not have to go through the pain, discomfort and recovery phase like a normal nose surgery.
People from all ethnic background can safely consider non-surgical nose job and get the looks they desire. The surgeon takes into account the ethnicity and does the filling to balance the aesthetics of the face and the patient’s ethnic identity.
What can non-surgical Rhinoplasty correct?
Non-surgical nose job can create a near perfect nasal profile just like the surgical nose job. But one limitation to this is that it cannot reduce the size of the nose or lessen the overall volume of the nose. Since the entire procedure is a filler process, you can only expect to have smooth contour of the nose.
- Depressed nasal dorsum leading to a flat nose. Injectable fillers increase the size of the nose and make it look proper to the contour of the face.
- Deviated projection of the nasal tip leading to lop-sided nostrils.
- Retracted or weak columella leading either to a droopy nasal tip or upturned nose.
- Deep creases along the nasal sidewalls
- Humps or depressions on the nasal bridge
- Enhancing interior nasal structure
- Any minor injury to the nose
Surgical vs. Non-Surgical Nose Job
|Surgical Nose Job||Non-Surgical Nose Job|
|Meaning||Incisions, cartilage addition/reduction/grafting procedures are carried out on the nose with surgical instruments||No incisions are made, only fillers are used through syringes to achieve the results|
|Time Required||Usually takes about an hour or more with full-fledged surgical unit, procedures and support staff depending on the complexity of the case||Usually is done within 15 minutes with just the basic formalities|
|Decision Making||Decision has to be made taking into consideration time, family support, availability, urgency of the matter, medical history, physical and mental fitness, funding, surgeon’s expertise, location of surgery, post-operative care, recovery time etc||Decision can be made quickly as the results are not permanent and the patient can get on with their day to day activities within a day|
|Consultation||Requires multiple consultations with many plastic surgeons (domestic and foreign)||Can be done with just one consultation and fixing of appointment|
|Hospital Stay||The patient is required to stay for one night before the surgery and may be one additional day after surgery if needed||The case is treated as out-patient, the procedures are carried out quickly and discharge given immediately|
|Cost||Ranging from $4000 to $8000 requiring fully functional surgical unit.||Less expensive and can be done at the doctor’s clinic. Usually costs in the range of $700 to $850 for one syringe|
|Bruising||Swelling and bruising is visible around nose, eyes and cheeks||Negligible swelling on the injectable area which quickly wanes off|
|Pain and discomfort||Pain is felt usually in and around nose area after the effects of anesthesia subside and discomfort remains for at least a week after surgery||No pain as the injectable fillers come with numbing agents mixed and there is no discomfort as well|
|Recovery||Takes about a year for complete recovery and permanent nasal profile setting in||Quick recovery with instant results|
|Risks Involved||Surgical risks regarding anesthesia, medication, surgical procedures, hematoma, internal bleeding, post-surgery infection, failed Rhinoplasty etc||Resistance or extreme reaction to the agents used in the fillers|
|Results||Lasts permanently with gradual decline due to wear and tear and ageing||Requires refilling after every 9 months or a year|
|Reversing Ability||Irreversible, but can be made good through a revision Rhinoplasty||Reversible, where the surgeon can control the filler and also melt any excess with Hyaluronidase acid|
|Insurance Coverage||Full or partial coverage if surgery is done for functional reasons (breathing problems) but not for cosmetic reasons||No insurance coverage as the procedure is purely done for cosmetic reasons|
|Recent Advancements||3d Imaging used to simulate post-surgery results showing patients an image of their future self along with improved surgical units and post-operative care||Extensive research and improvements in synthesizing injectable fillers to harmoniously become part of the body and not create extreme reactions|
Procedure for Non-Surgical Nose Job
The procedure involved is simple when compared to the surgical Rhinoplasty. The surgeon usually gets the job done in 15 to 20 minutes on any day and the patient is given discharge immediately. He can also resume his day to day activities the next day.
Some surgeons also give a saline injection to the patient to make them see, feel and experience what it is like to go through the injectable fillers. The effects last for about 10 minutes where the patient can decide whether this nose job is for them. After this, the actual treatment begins.
The step-by-step procedure
Step 1: Pre-operative Checkups – The surgeon may make some general checkups of blood pressure and other vital signs before starting to make sure that the procedures are completed smoothly.
Step 2: Administering Anesthesia – Usually for non-surgical Rhinoplasty general anesthesia is not given. Some physicians use sedatives while others use Lidocaine injection to numb the area.
Step 3: Injecting Fillers – A sterile syringe is used which comes pre-packed with filler agent and a hypodermic needle. The physician injects the material deep under to nasal skin in the subcutaneous tissues and creates the desired changes.
Step 4: Recovery – Slight swelling, discomfort and stuffiness can be felt in the nasal area after the filling. The patient can resume normal daily activities after an hour or so.
Step 5: Follow-up – Since the fillings are temporary, lasting for at most 1 to 1 and a half year, the patient has to go through future filling sessions until required.
Fillers Used in Non-Surgical Rhinoplasty
The earlier fillers used in non-surgical nose jobs caused adverse effects to the health of the patients. As such, the FDA stepped in and created many safety measures and control checks before administering these fillers. The surgeons have to take approval from the FDA before using any new filler agent on their patients.
Some of the modern injectable fillers are as follows
1. Hyaluronic acid – This is a naturally occurring substance and is found throughout the body of most living organisms. It is the reason behind skin elasticity, volume and appearance of the youthful skin. This is the only filler which is reversible. The surgeon can reduce the dosage by melting away the excess dosage by injecting another enzyme called Hyaluronidase.
- Juvederm™ – This is injectable facial filler used for cosmetic, dermatological and plastic surgery to soften deep folds and reduce wrinkles in the face. Its main usage is in removing “smile lines” and creases of facial skin. Various clinical studies were conducted over the years to check the efficacy of this agent. They proved that Juvederm is safe and gives better results than its competitor Zyplast, a filler made from collagen. This agent is FDA approved.
- Restylane® – This is a non-animal sourced hyaluronic acid (HA). This was the first acid filler in United States approved by FDA for cosmetic injection into deeper dermal tissues. This filler has been known to cause granulomatous (foreign body reaction). The filler should not be used near areas where there has been a skin disease or inflammation before. The filler has also been not tested on pregnant women.
- Voluma™ – This is a product which is used for similar reasons like other hyaluronic acids. The side effects are similar to Restylane® and should be used after skin testing and eliminating any possibilities of infection or adverse reaction.
- Perlane® – This is soft-tissue filler in the market approved to treat moderate creases around the mouth. The surgeons, however, are authorized to use this agent on other parts of the face to enhance the characteristics and rejuvenate the skin and volume. This is slightly thicker when compared to Restylane® and may be a better choice for filling deeper lines.
2. Calcium Hydroxyapatite – This is a calcium phosphate similar to the human hard tissues in morphology and composition. It is considered more stable when compared to other calcium phosphates. This is also more stable during physiological conditions such as temperature, pH and body fluids interactions.
- Radiesse® – This is an implant composed of synthetically produced smooth calcium hydroxyapatite (CaHA) microspheres suspended in a sodium carboxymethylcellulose gel carrier. This is FDA approved dermal filler requiring minimal invasive procedure producing immediate results. The filling lasts up to 14 months.
3. Liquid Silicone – This is a gel which is used through microdroplet technique over various sessions in the clinic. It is also used for breast implants, testicle implants, pectoral implants etc. Since the synthetic compound is highly bio-compatible it is advised by the surgeons for injectable filling. Only the medical grade silicone is approved by the FDA and its quality has to pass stringent tests before administering to the patient.
4. Polymethylmethacrylate(PMMA) – This is permanent filler made from microscopic plastic beads. A skin test is required before administering. Tiny PMMA microsphere are suspended in biological fluids and injected to deeper parts of the nasal tissues to restructure the nose.
PMMA is highly compatible with human tissues and as such is widely used for eyeglass lenses. It is also used as bone cement to affix implants and restructure nasal bone. Although this material is compatible it is considered a carcinogen and has been linked to cardiovascular events.
- Artefill™ – This is a permanent injectable wrinkle filler to smoothen out the smile lines. It was approved by the FDA in 2006. It is a gel suspension of 20% PMMA, 30 to 42 micron microspheres, 3.5% collagen derived from cows and 0.3% Lidocaine. Since this material is not absorbed by the body it provides a permanent structure into which the nasal tissues can grow. These can be removed only by cutting them. Artefill is not recommended for people who have bovine collagen/lidocaine allergy or sensitivity to foreign objects. There is also a risk of eventual overgrowth of tissues if the injectable is not controlled.
5. Polyacrylamide Gel (PAGE) – This is permanent filler used to achieve results like the usual surgical Rhinoplasty. This is used for patients with ethnic backgrounds. This filling is not approved by FDA.
- Aquamid™ – This is a non-absorbable permanent soft-tissue filler agent meant for cosmetic surgery. It contains approximately 97% water and 3% cross-linked polyacrylamide. The agent is released into the deeper surface of the nasal skin to correct wrinkles, folds and even out any asymmetrical shape. Various clinical trials over the years have been conducted to support the safety of this agent. But, FDA has not yet approved this agent in USA. It is available in other countries Europe, Asia, Latin America and Middle East.
Financing the Non-Surgical Rhinoplasty
Although the cost of injectable filler is just 1/10th of an actual Rhinoplasty surgery, you have to take into consideration the temporary nature of this procedure. You are required to visit the doctor’s clinic every year and spend the amount for the injection.
Sometimes, a single injection may not be enough for the entire procedure to be successful. The physician has to make use of another syringe which will add up the total cost. Therefore, if this idea makes you nervous, it is better to give a second thought before opting for a nose job without surgery.
The permanent fillers discussed above may not suit your body type and your surgeon may go for the temporary ones. Even with the permanent fillers there are possibilities of them creating an unwanted reaction in the body later on and you may have to visit the clinic again for replacing them with new ones.
The insurance company does not cover such cosmetic procedures unless a functional problem is proved through a medical test. Moreover, you should be careful and read through the clauses given in fine print of your health policy. You have check whether such cosmetic surgeries can make your future claims null and void.
If you decide to have your fillings off-shores, you may have to consider the currency exchange of that country and whether it would prove to be reasonable to you.
The banks may give you a personal loan depending on the prevailing rate or interest. But, if you have to go for a bank loan for a non-surgical Rhinoplasty, it is better to wait until your financial condition improves. It is always better to make the payment from your savings instead of creating a new debt.
Recent Advancement in the field of non-surgical nose job
With the emergence of Vectra 3d™ imaging technology the surgeon is able to take pictures of patient’s face and create a 3d image to show how the procedure will change the shape and size of the nose.
The technology also guides the surgeon by taking into consideration various angular calculations to provide the best results for surgery. It also takes into account the typical traits exhibited by people from various ethnic backgrounds and helps the surgeon maintain them while he is operating on the nose.
Final words on Nose Job without Surgery
Nose job without surgery is becoming more and more popular with the patients who are unwilling to shell thousands of dollars for a surgery. The mainstream media is catching up with the astounding results achieved by injectable fillers in enhancing the beauty of the face by correcting the nasal structure.
The temporary results are a boon in disguise, as, if something goes wrong and the patient is unhappy with the results he will know that the results will not last for long. Overall, this new technique in providing an aesthetically attractive nose is proving to be successful.
Watch this video where Dr. Robert Kotler does non-surgical rhinoplasty fillings on various patients while explaining the procedure in detail and taking feedback from the patients.