As rhinoplasty surgeons and revision rhinoplasty experts, we often come across patients who’ve started asking about “non surgical nose jobs,” “injectible rhinoplasty,” or “liquid rhinoplasty.” As a result, we have done a lot of research and work in the area, and even asked some of the country’s other foremost experts in rhinoplasty what their thoughts are on this new phenomenon. What follows is our genuine attempt to give the best answers we can presently find with regards to this potentially new exciting area in facial plastic surgery.
In the last 10 years, facial plastic surgery and cosmetic surgery, in general, have seen explosive growth in minimally invasive and non surgical procedures. For most patients the reasons for this are simple: you do not have the time for recovery from surgery; traditional surgery may cost too much; non-surgical implies and is marketed as “no or little risk”; surgery is painful.
As a result, the various fillers have seen an enormous increase in their utilization. And today, we use these various fillers to achieve younger, more symmetric appearances not just by filling in wrinkles but also by restoring lost volume. More recently some of these fillers, which have only been approved by the FDA for use in the nasolabial fold, are increasingly being used for an ever wider array of “off- label” procedures including reshaping the jawline and chin, filling the cheeks, and more recently to reshape the nose- ie the “non- surgical” nose job, “liquid rhinoplasty,” and “injectible rhinoplasty.”
Some facial plastic surgeons use restylane for injection rhinoplasty
Let’s start by pointing out that the idea of injecting materials into the nose is not new even though there are plenty of doctors publicizing that they are the ones who started “injectible rhinoplasty or non-surgical rhinoplasty.” The truth is that the idea of injectable rhinoplasty for correcting nasal asymmetry can be traced back over a hundred years. And in that time a lot of different materials have been used- olive oil, goose grease, petroleum jelly, fat, paraffin, silicone, and others. Unfortunately, the results of these procedures were less than favorable and all of these materials have fallen out of favor due to their complications.
In the past plastic surgeons have used a variety of different fillers for non surgical rhinoplasty
Presently, there are many doctors starting to inject the nose with the newer dermal fillers- Restylane, Radiesse, Perlane, Juvederm, and even Artefill. However, the fact is that there have only been a few small studies published to date and only on a few of these materials. Moreover, these reports have largely been case reports and pilot studies using a small number of patients followed for short periods of time- generally less than a year. As a result, no one can say that injectible rhinoplasty, even with these new fillers, is absolutely safe.
Radiesse and Juvederm are other facial fillers used by some West Hollywood Facial Plastic Surgeons when doing liquid rhinoplasty
Traditional rhinoplasty done by a good rhinoplasty surgeon who specializes in the procedure can cost anywhere from $5000 to $10,000; yes there are surgeons who will charge $20000 for primary surgery but they are the outliers. If you’ve had previously surgery and need revision done by a revision rhinoplasty surgeon, this cost can vary depending on the complexity of the problem from as little as $2,000 for a very minor tweak to $25,000 for a total nasal reconstruction.
With injectible rhinoplasty, the costs are between $1000 to $2000 for each procedure; however, how long these results last is unknown but, in general, most doctors have found the result is less than one year. The permanent fillers may be different but at this time few doctors are willing to subject patients to the risks involved with permanent fillers, until more studies are available.
So one of the questions with liquid rhinoplasty is how much are you willing to pay knowing in time you will have to do it again and again?
Risks, Complications, and Recovery
All procedures have potential risks and complications. As revision rhinoplasty surgeons, we are very aware that rhinoplasty is an exacting procedure that really should be done by people who specialize in the field, and we take great care in explaining to all our patients the possible risks of anesthesia and surgery. As for pain, our patients tell us this is not an issue. It may be because of the way we do surgery and because we do not use splints and packing in the nose, but almost unanimously our patients tell us that outside of perhaps a pill or two for pain that first night, that they experience little more than a dull ache or discomfort.
For injection rhinoplasty, the issues of safety are still largely unknown, especially long term. On the positive side, there is no need for anesthesia and this is great for both recovery time as well as in obviously negating all the risks that generally come with general anesthesia. The problem with using fillers developed for the nasolabial folds in the nose is partially due to anatomy. In the laugh lines, cheek and jawline, the skin is thick and has a thick layer of tissue deep to the skin. As a result, we are able to inject below the skin and restore volume without causing skin irregularities.
The anatomy of nasal skin is different and therefore an expert in rhinoplasty who understands this anatomy is important when considering Non Surgical Nose Job
Nasal skin is very different, and varies not only in different ethnicities but even in the same person from one area of the nose to the next. As a result, though the non surgical rhinoplasty is marketed as a “lunch time” and “15 minute” rhinoplasty, the truth is that patients can and often do have swelling and redness that can last for weeks. It can also result in: 1) Skin irregularities– occasionally when injected superficially it results in little bumps of the filler; 2) Infection– many doctors have found that material injected into the nose can result in both short term infections as well as serious chronic infections; though rare, it has occurred; 3) Bruising and hematoma– just like surgery, anytime you get an injection it’s possible to get bruising; 4) Skin necrosis– this is probably one of the more serious problems but thankfully relatively rare; the skin overlying the injected area can simply die. This is a devastating problem because its repair can be very difficult.
Aesthetics- How the nose looks?
There are two major problems with the aesthetics of injectible rhinoplasty: almost by definition injectible rhinoplasty = augmentation rhinoplasty; those doing non surgical rhinoplasty are not necessarily trained in nasal anatomy or aesthetics
Injection rhinoplasty is like augmentation rhinoplasty and therefore can refine the nose, but you have to be wary so that your nose is not made to look too big
It is often said that if one has only a hammer, over time everything can begin to look like a nail. With injection rhinoplasty, not everyone is a good candidate. Most patients who come in to see us want to have smaller noses or more refined noses. For some patients, especially those with thick skin and certain ethnicities, that does occasionally mean that in order to refine the nose we actually have to put cartilage in to add definition or build the bridge. As a result some of these patients are good candidates for injection rhinoplasty if they do not want a nose job. However, for all the other patients who present with a bump, a twisted nose, tip problems or breathing issues- injection rhinoplasty is simply not the best answer.
As facial plastic surgeons we spend a lot of time studying and developing our aesthetic sense, especially in relation to rhinoplasty, “nose jobs.” However, as we write this paper, injection rhinoplasty is being done increasingly by many physicians who do not have any training in the aesthetics or in the anatomy of the nose and face. And unfortunately for patients, unlike with surgery where a certain level of expertise is expected by you before you trust your face to a surgeon, a procedure like injection rhinoplasty is being marketed as a simple procedure with little risk. As a result a variety of physicians and physician allied professionals who may not have any expertise in the anatomy and aesthetics of the nose are now injecting the nose with semi-permanent or permanent fillers which can and do occasionally cause an array of devastating complications.
More studies regarding injection rhinoplasty need to be done in order to determine what materials, if any, are safe long-term. At the present time, we would recommend that patients who are interested in injectible rhinoplasty see surgeons and doctors who have experience in both injectible rhinoplasty and in surgical rhinoplasty; and as with all elective procedures you should see more than one doctor before you decide.No comments