I really don't want to keep going every six months or so, I just want it to be doe permanetly. How is this done?
Permanent Non Surgical Nose Job
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A permanent non surgical nose job is a surgical nosejob!
There are no safe methods of permanent non surgical rhinoplasty. Injection of permanent fillers like Artefill or Silicone into the nose should be strictly avoided and considered malpractice if performed! If the permanent filler becomes infected, treatment is extremely difficult.
Radiesse/Juvederm UltraPlus XC Works Well for Longer-Lasting Non-Surgical Nose Jobs (Non-Surgical Rhionplasty)
Intuitively it would seem that permanent would be better than temporary. In an ideal world that might be true, but it is not currently so in the world of volumizing fillers.
The most common permanent filling agents, silicone (not approved for aesthetic use), ArteFill, and Bio-Alcamid (not approved in the U.S.) are all foreign materials (not naturally found anywhere in the body) and, as such, cannot be metabolized or removed by the body's metabolic processes, cannot be dissolved by injections of any kind, and cannot always be removed surgically (leaving surgical scars). Hence, it anything goes wrong, or the results don't look quite right, the patient is stuck. In addition, lumps and bumps, known as granulomas, have also been known to form at injection sites, even many years after injection.
For these, and other reasons, I prefer to use a combination of Radiesse, a calcium-based volumizer, and Juvederm Ultra Plus XC, a hyaluronic acid-based injectable for non-surgical nose jobs.
Because the nose is not subject to much movement, it has been my experience that materials injected there last considerably longer than when they are injected in more mobile locations, such as the laugh lines. In addition, if any adjustment must be made to the treatment site, the hyaluronic acid component can be easily dissolved with hyaluronidase in a matter of hours to a couple of days. And, if one considers that most of us go to the dental hygienist two to three times per year or for yearly dental checkups, returning for a five minute non-surgical nasal touch up even less frequently than that is really not such a big deal.
Permanent non surgical nose job
There is no way to do a permanent non - surgical procedure in the nose. One very famous rhinoplasty surgeon once said that "All implants in the nose will eventually extrude" (forcibly come out). Silicone, Medpore, Gortex...etc...all implants in the nose, bare out to be horrible ideas. However, in my practice juvederm injections don't last 6 months...the last several years. Filler tends to be resorbed based on the location and more importantly the motion of that particular location. In the lips themseleves filler tends to last only 6 months, in the nasolabial folds maybe 9 and in the cheeks, closer to 12 months. In the nose, I have used it for touch ups as well as patient's who are not good surgical candidates (Wegener's granulomatosis, HIV, Immunosuppressed...etc.). It tends to last a LOT longer than stated. So its a very reasonable option. However, if you are truly interested in a "permanent" solution...surgery is the only answer.
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Permanent non surgical nose job is not a good idea.
This can only be done with silicone injections, and I don't know any good plastic surgeons who do that.
Permanent nonsurgical nose job with filler is malpractice?
Of course, a rhinoplasty will give you longer results than a filler procedure. It is difficult to evaluate whether a filler would even be beneficial for you, without viewing any photographs. But I certainly do not agree with the rather sharp, and not particularly useful advice you already received that use of a small amount of permanent filler constitutes malpractice. As an intermediate approach, Radiesse would likely last significantly longer than the 6 months usually seen with the HA fillers such as Juvederm or Restylane.
Rhinoplasty is the only form of permanent nose reshaping
Dermal fillers will always be temporary. Permanent fillers are not ideal for use in the nose. If you are happy with the results you are seeing using fillers in your nose, then I would advise to stick with it. Despite having to repeat the treatment, its more important that you are satisfied with the result.