The non-surgical or medical rhinoplasty is a technique for remodelling and reshaping the nasal framework with the use of dermal filler injections. It’s important to note that, as with many other filler techniques which target lines, folds and volume restoration, there are many complex structures to the nose, and the nasal anatomy must be understood before practitioners embark on correcting nasal deficiencies using filler products. It should only be considered by those with an intermediate or advanced competence in dermal filler injections.
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Before and after a Non-surgical “nose job” using dermal fillers
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Dear Dr Hugo
“I had seen the advert for Stratford Dermatherapy Clinic many times in our local press so decided to peruse their website. What initially drew me in were the ‘before and after’ photos of nose reconstruction using dermal fillers. Approaching 60, the chance to finally have something resembling the nose I had always wanted made me overcome my reticence at walking into, what I had imagined, would be an intimidating place. I needn’t have worried as Hugo and Karen are the most friendly and welcoming people. I left their clinic after that first visit walking on air.
Not only did I get my lovely ‘new’ nose, but some subtle enhancements to my lips and naso-labial lines. No trout pouts here! I just looked refreshed and less down at the mouth. Be warned, this is the sort of place that makes you want to go back for more. I have had top ups to the above treatments a couple of times now after approximately a year and 18 months. My nose has never reverted back to its original shape, but small top ups give me the confidence that it never will. Dr Hugo is also very honest and would advise strongly against any treatment he thinks you do not need.
Since then I have had annoying, small thread veins removed from my face and legs and my latest treatment, which I requested , was Pelleve. Two sessions have restored my jawline quite visibly and this is not even the final result as the results are progressive over approximately 6 months.
I am almost 63 and three people in recent times, independently of each other, have shown surprise at my age, believing I was around 52. I’ll happily settle for that. I will continue my annual pilgrimage to see Dr Hugo now until I drop, safe in the knowledge that I am in good hands. My only worry is that he will retire before I reach that point.”
Mrs D. H.
Firstly, some background. Rhinoplasty is the oldest known of the plastic surgery procedures, having been reported as a method for repairing broken noses in ancient Egyptian medical texts dated to 3,000 BC, as well as by the ayurvedic physician Sushruta in ancient India circa 800 BC who wrote about reconstructing noses which had been amputated for religious or criminal punishment.
The development of the forehead flap rhinoplasty is attributed to Sushruta; this technique was also used in modern day plastic surgery on soldiers who returned from World War I with facial trauma and is still a technique used in current practice for severe cases.
Given its history, rhinoplasty is probably one of the most written about and developed areas of facial surgery which has mostly remained unchanged in principle for several thousands of years; the aim remaining to correct nasal complications caused by trauma or birth defects.
In the modern era, the concept of a cosmetic rhinoplasty has evolved, with the surgery being less about a medical need to improve nasal function or correct a significant nasal deficit and more about a desire to improve on the look of the nose that god gave someone. Although not as old as surgical rhinoplasty techniques, the non-surgical procedure is not as new as we might all think. The concept of the non-surgical rhinoplasty started when surgeons who were performing traditional, surgical rhinoplasty procedures realised that when they were injecting the local anaesthetic into the nasal area they were getting a degree of correction from the simple addition of the lidocaine solution to the region; hence the seed of the idea for the use of injectables was planted.
The first reported case of a non-surgical rhinoplasty is from the late 1800s, when an American neurologist James Leonard Corning and a Viennese physician Robert Gersuny used liquid paraffin wax to lift a saddle nose deformity (collapsed nasal dorsum), needless to say, the idea was great, but liquid paraffin was soon discovered to be harmful to the patient!
It took until the 1960s and 70s for surgeons to experiment again, this time with medical grade silicone gels, however again complications were noted, often several years post injection, including ulcers and granuloma formation. Fast forward to the turn of the millennium and American Dr. Alexander Rivkin published his method for the nonsurgical nose job or ‘injection rhinoplasty’ following a year’s experience injecting Restylane® and Radiesse® in 2003. The main observation attributed to Dr. Rivkin, which is the primary confusion with how this technique works, is that he observed that straightening the nose actually made it appear smaller, even though he was augmenting the tissues with the filler, yet by making it all blend better with the contours of the rest of the face it achieved the aim that until then could only be done by surgery. In 2009 he published a study of 385 patients which remains the largest published experience with this injection rhinoplasty technique in the world.
Since then, many more practitioners around the globe have trained in and practiced the technique and more clinical trials are ongoing looking at the use of differing filler products.
A non-surgical rhinoplasty is an ideal option for adult patients who perhaps have a contraindication for surgery, who have previously had surgery, but had unacceptable results, who simply cannot afford a surgical procedure, or for those who are considering a surgical procedure and see this as a stepping stone towards how a ‘new nose’ might look, before they commit to going under the knife.
Similarly though, it is not an option for all patients with the usual contraindications in place for those with acute or chronic skin disease, pregnancy, allergies or intolerances to the filler materials being used or those who have had previous rhinoplasty surgery but which resulted in complications with compromised bloody supply.
The attraction of a non-surgical rhinoplasty, for both the practitioner and the patient is that it is an office or in-clinic procedure, no need for a sterile operating room. It requires no anaesthetic, a topical may be used but many filler products nowadays come with the addition of 0.3% lidocaine for pain relief. It is also considered to be a no-down time or lunchtime procedure which allows the patient to return to normal life inside of a couple of hours with little bruising and trauma, compared to a surgical rhinoplasty. Patients simply require aftercare protocols for 24-48 hours which include no exercise, no heavy make-up on the nose and no wearing of prescription or sun glasses. Of course, unlike with a surgical procedure, the results of a non-surgical rhinoplasty are not permanent and the patient is likely to need repeat or top-up treatments to maintain the desired results every couple of years.
The technique can however be used to address a number of nasal concerns, including augmenting a flat nasal bridge (depressed dorsum), adding projection to the nasal tip, reducing nostril size, reducing the perceived size of a nasal hump (straightening the nasal line makes it look smaller), correcting nasal septum concerns, elevating a saddle nose deformity, filling depressions in the side walls of the nose and other corrections or enhancement of the nasal anatomy due to the underlying bone structure. As well as the use of dermal filler products, small unit doses of botulinum toxins can also be combined (for off-label uses), for example used at the base of the nose to aid with the elevation of the nasal tip.
Understanding the anatomical structures of the face is your number one priority. Addressing the nose for non-surgical rhinoplasty treatment is no different.
Aesthetics Of course, the difference between the ceiling in The Sistine Chapel and the ceiling in your local church is the artistic approach to the plaster work. This is no different when working in facial aesthetics. As well as the importance of understanding the anatomy, it’s similarly as important to consider the artistic approach taken to any rhinoplasty procedure, whether surgical or non-surgical. Patient satisfaction is key, so, achieving a nose which both corrects the deficiency or deformity and meets the agreed expectations of a ‘beautiful new nose’ is the aim. This means taking into account the important angles and symmetries of the face, so that a balanced and desirable nasal correction is achieved with the procedure.
The filler-injection technique allows for:
As with other aesthetic procedures, possible complications of the procedure can include infection, hematoma, discomfort, anatomic asymmetry, or foreign body reaction (called granulomas). Granulomas are extremely rare, and are most seen with impure silicone and some non-HA fillers.
The procedure for injecting and placing the soft-tissue filler typically take 10 to 30 minutes to perform in the our consultation room, after an initial 15 minutes of numbing, if anaesthetic is required. After the procedure, the patient can typically resume normal life activities immediately.
