Ten years ago, nobody was doing non-surgical rhinoplasty it was
unheard of and most rhinoplasty specialists like myself frowned
upon it. We didn't want anything injected into the nose for fear of
scarring or infection. But over the last five to six to seven years,
we've noticed that if you choose the right substance and by the right
substance, typically, it's Restylane, Juvederm or Belotero, one of the
hyaluronic acids. You can get a really nice result in a significant
portion of patients, but not all patients so you have to choose
properly. I think too many patients go to an average dermatologist, get
something injected into the nose and up with a larger nose with not
necessarily and attractive nose. So the same rhinoplasty, aesthetics,
the same goals of a beautiful nose have to apply what you do in the
surgical or non-surgical rhinoplasty.

The reason that I like the hyaluronic acid is that they're safer. One,
they can be removed and dissolved if you want to, but there are also
clear soft gels. Some people come in asking for silicone, artefill or
more permanent fillers that doesn't belong in the nose. Permanent
fillers come with permanent problems. I've seen patients come in who've
had permanent infections with permanent fillers in their face and you
have to cut it out like cancer or put them on high dose antibiotics, put
them into the hospital, give them intravenous antibiotics. If somebody
has had an implant abroad, the implant can be easily removed, but a
filler consists of thousands of particles and you can't easily remove
it. So safety is first. If you got to do something, that's when we want
to be safe.

The other important aspects are what we talked about as the aesthetics
of the nose. You can't just put a filler into the nose. We have to know
what the [inaudible 00:01:38] height should be, what the tip projection,
rotation. All these issues are important and you have to understand that
it starts at the nose. Take a look at the patient. Examine the patient
and then have a discussion. I used computer imaging on almost most cases
of non-surgical rhinoplasty so they can see themselves what they can
look like. Now, in this case, we have a beautiful young woman who was a
small dorsal hump. Dorsal hump is luckily surrounded by an area that's
depressed above it and depressed slightly below it. So in this
situation, to get a straighter bridge, you can place a little bit of
filler above into the area of the bony dorsum or the [inaudible
00:02:17] Now, a little bit of filler to the area, the secret tip giving
it straighter profile. It's important not to try to go for perfect
treatments sometimes because if we try to get a perfectly straight, it
maybe a little bit too high, so it's important to keep that in mind and
the goal is to reduce the appearance of the dorsal.

Now, there are things that adding volume does. When you raise the bridge
a lot of times, it makes the nose look nicer and narrower. Surgically, I
could break the bones, do as the other is and make it narrower as well.
Nonsurgical, I can't do that, but by adding a little bit of filler to
the bridge, you can give the illusion of narrowness. Surgically, I can
lift the tip off a little bit. Like to narrow the nose just a little
bit. Nonsurgically, can't do that significantly, but overall, you can
still got a nice nose. It's important for her to be balanced in the
face, age appropriate, sex appropriate, ethnicity appropriate to
drastically change the nose. And I'm going to demonstrate that technique
right now. so we have Restylane again. The clear gel, the beauty of
Restylane is it's smoothness. It comes with a 29-gauge syringe. You want
to make sure you have the bevel down. The tip should be down. I don't
want to be inserting this under the skin. You want to be right on top of
the bone or cartilage and I want to demonstrate. So I'm going to start
up here. I'm going to grab the skin, a little bit of it. Be gentle.

There's no reason to be rough with the skin. I've seen some people
believe that if you penetrate the skin quickly, there's less pain. It's
just not true. And you can see, it's little tiny drops, but these are
not very large drops by any means. And then you mold and massage as you
go. The nose is not as vascular as the eyelids and other areas so
believing in bruising is less common, which you still have to be aware
of the surrounding. Good. You can drop the camera angle and see it again
right here. How beautiful that profile is. There is no bump
left anymore. You can see how straight that bridge is. Now, I'm
going to consider putting a little bit to the tip to just give that a
lift. What do you think of that?

Female Voice: Sure, if it looks good….

Non-Surgical Rhinoplasty Eliminates Small Dorsal Hump

Non-permanent filler Restyline is used in order to provide a patient with the illusion of a straight bridge.