Restylane to Fill the Crease on the Nose?

Question

I have a really turned up nose, but I don't mind that as much as the crease RIGHT down the center. I'm very conscious of it as I model a lot and it makes a shadow in photos and ruins them! I'm afraid to get anything permanent. I already had Botox. Is there an injectable that can round out the crease? Could an injectable cause scarring? Also, what average cost would I be looking at? Thanks.

David C. Pearson, MD · Answer

While traditional surgical rhinoplasty provides much wider options in terms of reshaping the nose, filling in a bifid tip such as you've shown, can be a simple in-office procedure.
For non-surgical rhinoplasty, I typically start with a temporary filler such as Juvederm so that the patient can see whether they like the effect without having committed to something permanent. If they enjoy that look, then a permanent filler such as Artefill can be used.
Using temporary fillers only requires returning to your doctor every few months to every year for the rest of your life. That gets expensive and tiresome for patients. Fillers and surgery both carry risks, too, so be sure to discuss that in detail with your doctor.
All the best,
--DCP

Nelson Lee Novick, MD · Answer

I have been performing nonsurgical rhinoplasties for well over a decade and I have found that treating a bifid nasal tip (a vertical cleft down the center of the nasal tip) with fillers yields consistently gratifying aesthetic improvement. I find that a combining a small amount of Radiesse with Perlane L works best for this purpose; the combination gives good lift and yields quite durable (long lasting) improvement. If, before treatment, you wish to get an idea of what the result might be, the cleft can be filled with a small amount of saline or anesthetic solution, both of which are reabsorbed completely in a few minutes after which the actual treatment can be performed. You should of course seek treatment by a board certified core physician with extensive experience with nonsurgical rhinosculpturing.

Eric M. Joseph, MD · Answer

I think you're an excellent candidate for a Non-Surgical Rhinoplasty treatment. You appear to have very thin skin, and firm tip-cartilage so you can see the vertical crease in between your two lower-lateral cartilages. Your thin-skin / firm cartilage combination makes you a challenging Rhinoplasty Surgery candidate. I would strongly suggest keeping surgery as a last resort.
I know you don't want anything permanent, but I have had excellent success correcting this crease using Silikon-1000. All of my experience with Non-Surgical Rhinoplasty over the last 10 years has been with Silikon-1000, and I have no personal experience with temporary fillers in the nasal tip. The injection must be at the correct depth, so the experience of your physician is critical.
You should consult a facial plastic surgeon experienced with Non-Surgical Rhinoplasty, and you should see many photos before you proceed.
I hope you find this helpful.

J. Vicente P. Poblete, MD · Answer

This concern can be addressed surgically or non-surgically. If you elect the non-surgical route, you can start with temporary fillers - restylane/perlane or juvederm ultra/ultra plus. If you are happy with the correction, you can move on to fillers with longer duration - Radiesse, in this case. 
another option would be to correct this surgically - manipulating the lower cartilages in the nasal tip, but that is a totally different alternative that is much more involved than just injecting fillers. I wish you all the best in addressing this concern and your modeling career.

Scott E. Kasden, MD, FACS · Answer

The crease is due to your strong cartilages that diverge causing a depression between them.  Lights cast a shadow, and your photos are ruined.
Filers may be a temporary fix, you may want to look into a rhinoplasty.  There are other elements about the tip that may actually enhance the beauty of your face, and therefore may be advantageous.

Charles Perry, MD · Answer

While non-FDA uses of Restylane and Juvederm such as filling creases in the nose have been reported they are not without risk. Specifically skin loss and prolonged healing or permanent scarring. That being said, they can in small amounts injected by an experienced surgeon help to soften some static creases as seen your picture between the domes of the lower lateral cartilage. You nose is very pretty however as it is and I would suggest that the filler may round out the tip a bit and this may look different but perhaps not better if overdone. Best wishes hope this helps. I would suspect you might pay anywhere from $350 - $650 for an injection.

Shervin Naderi, MD, FACS · Answer

Hi,
The "crease" that you see is the bifidity or separation between the domes of your Lower Lateral Cartilages and the reason you are seeing them is that your skin is VERY thin and the cartilages are strong -- in your situation.  Every patient's anatomy is unique.
Surgically, crushed cartilage or alloderm or fascia can be placed over the area like icing on a cake to cover it.  Non surgically, Juvederm or Restylane can be injected conservatively to "fill in" the area but you have to be very careful because serious problems and scar tissue can form in such cases with fillers.

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