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  • By Alexander Rivkin, M.D.

    Traditional cosmetic procedures such as rhinoplasty, blepharoplasty, facelifts, and chin augmentations are no longer the only option for individuals who wish to enhance their outward appearance. These surgical procedures are now in competition with the latest innovations in injectable filler techniques. Products such as Radiesse, Artefill, Juvederm, and Sculptra allow a skilled physician to gently mold and sculpt the face. Facial fat disappears as we age, changing our appearance from full and youthful to gaunt and fatigued looking. Fillers will replace that fat, giving us back the youthful fullness that is lost over time. In addition, fillers can easily soften and camouflage aesthetic irregularities of the face, such as a nasal bump or an asymmetric chin. With so many new choices in aesthetic medicine available, why endure painful, invasive surgery that requires anesthesia and an overnight hospital stay? In this article I would like to specifically focus on Non-Surgical Rhinoplasty, also known as the Non-Surgical Nose Job, and discuss some of the procedure’s advantages relative to surgical rhinoplasty techniques.

    As a surgically trained otolaryngologist/facial plastic surgeon I understand my patients fears and anxieties associated with “going under the knife.” I have devoted my career to developing cosmetic surgery alternatives in order to reduce recovery time, discomfort, and financial cost to patients seeking cosmetic improvements. Recent developments in aesthetic medicine have allowed me to focus on minimally invasive facial sculpting as new varieties of injectable fillers are becoming more readily available in the US market. Four years ago, I was the first in the United States to offer Non-Surgical Rhinoplasty using injections of Radiesse to raise the bridge of the nose and camouflage bumps. Since then, I have performed about 1000 successful procedures and have trained physicians across the country and abroad.

    The idea of correcting nasal abnormalities with the use of injections is actually not new. In the mid 1800′s doctors attempted to perform this procedure with substances like paraffin, silicone, and goose grease. These techniques did not last because the substances used caused long-term side effects and turned out to be inappropriate for injection. However, the idea of performing rhinoplasty with injections remained a possibility and modern cosmetic surgeons continued to experiment with the idea of minimally invasive facial sculpting.

    When I started using Radiesse to fill in lines and wrinkles, I was impressed with the longevity and smoothness of the results. I had heard rumors that Asian plastic surgeons were using fillers to contour the nose non-surgically and I recognized the possibility that American patients could obtain results similar to traditional rhinoplasty without surgery. I questioned why US surgeons were only offering fillers as a post-rhinoplasty corrective procedure. There was (and still is for the most part) a perception that an operation is the only way to correct cosmetic nasal irregularities, even the most minor bumps or asymmetries. After using injectable fillers as an alternative to rhinoplasty for four years, I am convinced that the Non-Surgical Nose Job is a procedure that is safe and effective with significantly less discomfort and risk than traditional rhinoplasty.

    With proper administration from a trained specialist, Non-Surgical Rhinoplasty can effectively correct a mild to moderate bump on the bridge of the nose, a mild to moderate drooping of the nasal tip (nasal tip ptosis), mild to moderate post-rhinoplasty asymmetry, and mild to moderate deformities such as “boxer’s nose” or an upward scooping of the nasal tip (also known as saddle nose deformity). Skill and experience are required if a physician wishes to correct more difficult situations such as asymmetric nostril shape, or poor definition at the point between the face and nostril wing.

    Dr. Rivkin, Nose Job

    (Left: Before, Right: After)

    Cosmetic concerns often vary between ethnic groups and the Non-Surgical Rhinoplasty procedure can present the best solution across cultural lines. For example, Asians often desire a heightened bridge of the nose and want better nasal definition. African Americans, like Asians, often request bridge augmentation while Hispanic Americans frequently ask for correction of a droopy nasal tip or irregular bump. Caucasians most commonly request camouflage for an obvious hump or unbalanced appearance of the nasal bridge.

    Dr. Rivkin, Rhinoplasty

    (Left: Before, Right: After)

    Individuals who have already received a traditional rhinoplasty procedure commonly ask for minor corrections of asymmetry, augmentation for an upward slope of the nose, and, occasionally, a desire for augmentation and camouflage in the of the nose bridge due to a post procedure cartilage collapse.

    There are several injectable fillers available on the US market today that are safe, effective and relatively long lasting. I have mostly used Radiesse and am very comfortable with this filler. Radiesse is composed of calcium hydroxyapatite microspheres in a polysaccharide gel carrier. Since there is no way to dissolve the material, it must be injected with great care. I routinely under-correct because over correction is quite difficult to resolve. Immediately after injection, Radiesse is malleable and I will contour and shape it according to the needs of the individual patient. Generally I see patients one to two weeks after the initial procedure so that I can administer touch ups if necessary. Radiesse is a semi-permanent filler and generally lasts between 10 and 12 months. Because Radiesse is not animal based, no allergy testing is required.

    Some patients choose to start with more temporary hyaluronic acid fillers such as Restalyne or Juvederm in order to experiment with the outcome of their cosmetic makeover. The advantage to the hyaluronic acids is that they can be easily reversed with an enzyme in the rare event that results are dissatisfactory. After trying out their new look with temporary fillers, patients can then choose to go with a permanent filler if they decide a re-contoured nose suits their expectations (which is the case with most people). Restalyne and Juvederm last between six to nine months and are non-animal based so skin testing is not necessary and allergic reactions are unheard of.

    Although the Non -Surgical alternative to rhinoplasty is an excellent option for many, it is not the best solution for all patients. Patients with a severely crooked nose may not be good candidates for an injection rhinoplasty because the augmentation needed to give a straighter appearance to the nose may make the nose too wide. Patients with a nose that is disproportionately large may need to opt for a traditional reduction surgery. The procedure will not correct breathing problems.

    As with any medical procedure, selecting the right physician to perform your Non-Surgical Rhinoplasty is critical. Injecting filler into the nose must be done with care and a thorough understanding of both nasal anatomy and the properties of the filler being used. A patient contemplating this procedure should make sure his or her physician has had specific training and experience in cosmetic injection techniques, especially if the doctor is not a formally trained aesthetic surgeon. Precise knowledge about the injection spots, depth, and amount of filler needed is very important for the success of the procedure.

    Non-Surgical Rhinoplasty is a relatively painless procedure that requires minimal downtime and post-procedure care. In fact many of my patients have resumed normal activities immediately after their Non-Surgical Nose Job, returning to work or a busy social calendar on the same day as the appointment. Slight bruising or swelling may occur at the site of injection, however the severity of the inflammation pales in comparison to the aftermath of traditional rhinoplasty. If discoloration or tenderness does occur, it usually disappears within a few days.

    Topical anesthesia is adequate for pain control and icing the nasal area just before injection reduces the chances of bruising. I suggest patients take Arnica Montana orally after their injection – it works well for reducing any swelling or bruising that may follow. Patients can use Tylenol, but should not use non-steroidal anti inflammatory medications (Advil, Alleve, etc) for 3 days or wear sunglasses for 2 weeks after the procedure. No other limitations are required. The Non-Surgical Nose Job usually takes between 10-15 minutes to perform. Patients are usually in the office for about an hour, however, when we figure in the time needed for topical numbing cream.

    Non-Surgical Rhinoplasty costs a fraction of the price of the surgical procedure. Depending the on the filler being used – temporary, semi-permanent, or permanent – a Non-Surgical Nose Job costs between $1,000 – $2,000.

    Minimally invasive procedures like Non-Surgical Rhinoplasty are quickly gaining popularity because they offer patients exactly what they want cosmetically, but with much less pain, downtime, and cost. The Non-Surgical Nose Job is currently performed throughout much of the world and will only increase in popularity as the possibility of non-surgical aesthetic corrections continue to be publicized.

    About the Author

    Dr. Alexander Rivkin, Facial Cosmetic SurgeonAlexander Rivkin M.D. is a Yale trained facial cosmetic surgeon and UCLA faculty member who focuses exclusively on providing his patients with the latest in non-invasive, non-ablative cosmetic treatments. As an international authority on non-surgical cosmetic treatments, he divides his time between patient care, clinical research, educating other physicians, media appearances, and lecturing at scientific conferences throughout the world. Dr. Rivkin was the first physician in the country to offer the Non-Surgical Nose Job, his signature method for non-invasive correction of cosmetic nasal irregularities. He has been featured throughout the national and international media on shows such as the TODAY show, the Tyra Banks Show and EXTRA for the innovative procedures he has invented. Dr. Rivkin is a member of the teaching faculty of the American Academy of Facial Plastic Surgery. He is also a prominent member of the national teaching faculties for Allergan, Contura, Johnson and Johnson, Medicis and Bioform. Click here to learn more about Dr. Alexander Rivkin.

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    Comments

    1 Comment so far

    1. Jan on July 7, 2009 4:26 am

      For patients who have undergone a non surgical nose job, please share your experiences and reviews at http://www.nonsurgical-nosejob.com

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