The same dermal fillers that provide volume in facial rejuvenation are effective when treating the nose. The advent of the new generation of injectable agents such as hyaluronic acids (Restylane, Juvederm) and Radiesse, a calcium based filler have provided a quantum shift in the ability to treat soft tissue changes of the face secondary to aging. It is possible to re-volumize and treat the forehead, temples, brow, lower lids, cheeks, nasolabial folds, jawline and chin. The same agents are just as effective when treating the nose. For those born with cosmetically imperfect nasal features, these injectable agents are able to treat virtually all minor cosmetic issues and can in many cases mimic the result of a surgical rhinoplasty with the exception of the functional breathing component. Injectable nose reshaping provides an alternative to surgery if timing, a minor alteration or budget is of concern. In most cases one treatment can adequately deal with the vast majority of aesthetic priorities. Occasionally a touch up will be required once swelling has resolved. Bruising is rare and swelling is expected the first 24-48 hours. The treatment takes about 30 minutes and is done with a local block. While many patients are satisfied with their injectable nose reshaping and are happy to be re injected every 2-3 years, others use this procedure to gain confidence and trust by test driving the physician’s aesthetic and then move forward with their plan for operative rhinoplasty. Injectable Rhinoplasty allows the patient to “test drive” the surgeon’s aesthetic style as well as his or her bedside manner. Injectable rhinoplasty allows patients to preview a surgical result in a more realistic fashion than computer imaging where virtually any change can be drawn on a computer screen. CAD is not as legitimate as many assume. I prefer to show actual “before” and “after” photos of other patients with similar conditions. Fillers can enhance a surgical rhinoplasty post operatively.  When minor irregularities are present after surgical rhinoplasty, fillers can help avoid the necessity of additional surgery to make subtle corrections. In fact, injectables may be a more well suited and accurate modality when treating minor soft tissue irregularities. Correcting a droopy tip with injectables is actually an anti-aging procedure. The nose changes with aging of the face. Contrary to popular belief the nose does not technically grow bigger or longer. It does however change shape—especially the tip. Pointing the tip upwards with injectables can soften the patient’s appearance. There are certain conditions where surgery is the better/only option for the desired result. Patients who are candidates for functional reconstruction (e.g. deviated septum) cannot avoid surgery. Injectable rhinoplasty will not address a broad or boxy tip or a nose that is too large. However, the illusion of a smaller nose can be created with carefully placed injections at the tip and between the eyebrows.
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New York Plastic Surgeon