Nonsurgical Rhinoplasty (Nose Job)

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The use of facial fillers can be very effective in certain cases where reshaping the nose is desired:  nonsurgical rhinoplasty.  The advantage is that this procedure is quick, relatively painless, and requires no downtime or recovery.  For obvious reasons, it is also much less expensive than traditional rhinoplasty.  

Another advantage is that the procedure is temporary and reversible if hyaluronic acid fillers are used.  This allows the patient the opportunity to live with their new nose and see if it is what they are wanting.  If they are pleased with the result then a longer/semi-permanent filler such as Bellafill can be used. 

Additionally, filler can be combined with neuromodulators, such as Botox or Dysport, to relax muscles which can distort the nose.  This can be used to treat bunny lines and relax muscles that case the tip to drop when smiling or the nasal ala to widen with facial expressions.

Fillers can be use in many ways to mold of shape the nose:

     -  camouflage a dorsal hump or bump making the nose appear straighter

     -  augment the nasal tip to give a more round and less sharp appearance

     -  fill in depressions to provide better nasal symmetry

     -  augment other areas of the nose such as: 

          -flat nasal bridge

          -nasofrontal angle

          -nasal radix

          -nose projection

     -Aging nose:  lifting the nasal tip and widening the radix to give a more youthful look

It is important to remember that adding filler to the nose by definition will give volume.  This makes the nonsurgical rhinoplasty not useful for every patient.  It particular, patients with large noses who desire reduction rhinoplasty will not benefit from this technique.  

The choice of filler is also very important and should be discussed as part of the procedure.  There are several options which are effective:

     -Hyaluronic Acid Fillers:  Juvederm, Restylane, Vollure, Volbella, Voluma, Belotera.  These fillers use a soft, natural gel which is pliable and lasts about a year in most cases.  This is an excellent choice for first time patients who have never undergone nonsurgical rhinoplasty.  One primary advantage is that these fillers can be reversed with hyaluronidase if the effect is not something the patient wants.  

     -Calcium Hydroxyapatite Filler:  Radiesse.  Radiesse is comprised of Calcium Hydroxylapatite (CaHA) microspheres suspended in an aqueous gel carrier. Once injected, it provides immediate volume and correction but continues to work by stimulating the body to produce its own natural collagen.  By stimulating collagen production, Radiesse does have a desired effect on the nasal skin but has the drawback that it is not reversible.

     -Collagen with polymethyl methacrylate (PMMA) microspheres:  Bellafill.  Bellafill is a semi-permanent filler which uses PMMA microspheres to stimulate collagen production.  Bellafill is best for patients who have undergone nonsurgical rhinoplasty and know exactly what they want.  Bellafill is very long lasting and cannot be reversed.

In consultation with your surgeon, it is important to fully understand what can be accomplished with nonsurgical rhinoplasty.  It is very helpful to bring a photo with you of what you want you nose to look like.  This will allow your surgeon to see if that expectation is realistic with nonsurgical rhinoplasty.  It is also important to understand the difference between a nonsurgical technique and a formal rhinoplasty.  The rhinoplasty procedure is much more powerful and can address all aspects of the nose:  both augmentation and reduction variances.  The nonsurgical technique, however, can be effective for select indications and has many advantages:  cost, no downtime, minimal risk, and reversibility.

Dr. John L. Burns, Jr., MD

President, Dallas Plastic Surgery Institute

Dallas, Texas

Article by
Dallas Plastic Surgeon