"I had a bad nose job! I'm scared to get another operation! Is there anything else that can be done?!"
Non Surgical Rhinoplasty (Injection Rhinoplasty, Non Surgical Nose Job) is an option that is safe, effective, inexpensive, relatively low risk and easy to undergo. It is not the right option for every rhinoplasty revision, but it certainly deserves consideration.
Most of the time, surgical rhinoplasty is performed well, by competent surgeons and the patient ends up with a cosmetic result that is satisfactory. This article is not about that kind of situation.
Many patients feel that the only way to correct an unsatisfactory surgical result is with more surgery. This is not necessarily the case. All surgery causes some degree of scarring, some of which is hard to anticipate, even by the best surgeon. There is always some element of risk that a surgical rhinoplasty will not turn out exactly the way it is planned. This risk is considerably greater in revision surgery. The surgeon is working with tissues and planes that have been altered and scarred. The procedure becomes much more complicated and risky each time it is revised. Sometimes, surgical revision is really the best option. Sometimes, however, a simple filler injection can solve the problem.
The FDA has approved several excellent fillers that can be used to correct post rhinoplasty cosmetic defects. These fillers are safe, relatively cheap and do not incur lengthy recovery time when they are injected. Juvederm or Restylane are the most commonly used hyaluronic acid (HA) fillers. These can be injected under the nasal skin to fill out minor asymmetries or indentations left over after surgery. The advantage of these fillers is that they can be easily reversed with hyaluronidase if the patient is not satisfied. HA fillers are soft and look and feel natural. The downside of using these fillers is that they are not firm enough to withstand much tension if injected into an area that is scarred. They should be used only if there is not much scarring and the correction needed is very minor. Correction with HA fillers lasts about 6 to 8 months.
Radiesse is a filler containing calcium hydroxyapatite particles. The material is fully biocompatible (no allergic reactions) because it is the same calcium that is in the teeth and bones. Radiesse is injected deep into the nasal skin and is strong enough to keep its shape even when injected into areas of scarred tissue. It is not reversible, but when used by an able and experienced physician, Radiesse gives great correction. It can be used in any area of the nose, from the radix at the top to the nostrils and tip. Correction should be done over several sessions, taking care not to over-inject skin that has already been weakened by surgery. The danger of over-injecting post-rhinoplasty skin, especially in the tip area, is that the filler will compromise the blood supply to the skin and damage it. The cosmetic results of Radiesse injection last for 10 to 14 months.
The other filler that is being used in the nose currently is called Artefill. It is currently the only FDA approved permanent injectable filler. Because it is permanent, it should only be used by the most experienced injectors of the nose. Artefill is injected similarly to Radiesse, but over more sessions. The best way to inject is in a gradual layering of the product over 4 or 5 months. Once the desired effect is achieved, results are permanent. Artefill is composed of methyl methacrylate in a bovine collagen carrier. Currently, skin testing is required prior to Artefill injection to make sure that the patient does not have a rare allergy to bovine collagen.
Non surgical revision rhinoplasty options are available and, with the right doctor, can be an outstanding solution. As always, make sure that the doctor is experienced, ask to see before and after photos of his or her work and be certain that you are communicating your concerns and aesthetic goals as clearly as possible. You should always feel comfortable that the doctor understands exactly what YOU want and do not want.
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