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Tag Archives : non surgical nose job

Liquid Rhinoplasty Procedures

Basically, anything non-surgical, or liquid is exploding in popularity in my office right now. The most popular of the popular is the liquid rhinoplasty. Liquid rhinoplasty is a procedure that uses Botox and facial filler injections to change the shape of the nose. At this time last year, I was performing about one liquid rhinoplasty per month. Now, it’s more like two or three per week!

In this liquid, non-surgical procedure, a combination of Botox and facial fillers are injected to achieve the desired result without a scalpel. In the right candidate, a liquid rhinoplasty can even out irregularities along the bridge of the nose, make the nose appear straighter, raise the nasal bridge, or camouflage a dorsal hump on the profile view. Although you are technically adding volume with filler, the end result is often a nose that appears smaller and more refined. The idea is to change the way light hits your nose, creating a kind of semi-permanent contour makeup on your nose. During a liquid procedure, ice is used to numb the skin, and small needles are used to inject filler and/or Botox.

Not all nose concerns are amenable to liquid, non-surgical, rhinoplasty, but if you’re among the lucky (or unlucky, depending upon how you look at it) for whom this procedure can work, you can skip the pain and recovery of surgery. Results are dramatic and instant, and so are the savings! As compared to surgery, non-surgical rhinoplasty saves time, money, and pain. For most patients, there is essentially no downtime. The major downside is that the procedure is not permanent – depending on the filler selected, the results generally last from 1-2 years. Sounds like a good deal, no?

It is important to note, however, as we become more accepting of the idea of being poked and prodded with needles as a part of our routine beauty upkeep, that all of these injections, while effective, and amazing when done properly and subtly, are not without risk.

Vascular compromise leading to skin necrosis (actual death of skin because of decreased blood flow to the area) is the dreaded risk of non-surgical rhinoplasty. It can either occur from filler material actually getting into blood vessels, or from filler material pushing on blood vessels under the skin. While appropriate training and experience can help to minimize the risk of this occurring, the risk is never zero.

Studies have shown a rate of vascular compromise after filler injection of approximately 0.05% even in the hands of highly trained physician injectors. That equates to approximately 1 in 2000 times that facial filler injections are performed in the nose. Thankfully, vascular compromise is exceedingly rare, and when treated promptly and correctly, will resolve without long-term consequences. But that is the key – it must be attended to swiftly and expertly. If not treated appropriately, long-term consequences can be serious.

This is the reason that you should always ALWAYS be sure that your injector is properly trained, and knows how to handle vascular compromise after filler injection, whether they have personally experienced it first hand or not. All physicians who inject hyaluronic acid fillers like Juvederm, Restylane, Perlane and Belatero, should be stocking hyaluronidase in their office (this is the enzyme that breaks down the hyaluronic acid fillers used for liquid rhinoplasty).

Bottom line: While non-surgical rhinoplasty can be amazing, and is often quick, easy, and effective 1,999 out of 2,000 times, it is not without risks. Choose a plastic surgeon or dermatologist who is well trained, competent, approachable and responsive to you and your concerns.

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Curious about Nose Jobs? All Your Rhinoplasty Questions Answered

Curious about nose jobs? Get all your nose-y questions answered here.

Nose reshaping is extremely common. Chances are that you know someone who has had a nose job…you may have even contemplated changing your own nose. According to the American Academy of Facial Plastic and Reconstructive Surgery statistics, rhinopalsty, or the “nose job”, has remained the most requested surgical procedure for both men and women for five years in a row.

Rhinoplasty procedures, including primary (first time) nose jobs, revision nose jobs, functional nose surgery, and “liquid rhinoplasties” (nose reshaping without surgery) occupy the majority of my time. There are many options available for improving the nose – in both form and function. The terminology, however, can be confusing. Here I will explain the different options as simply as possible.

Liquid Rhinoplasy

The least invasive option is the non-surgical, “liquid” rhinoplasty.  During a liquid rhinoplasty, a combination of Botox and facial fillers like Juvederm are used to reshape the nose. This treatment is best suited to camouflage a “dorsal hump”, or bump on the profile view of the nose, but works well for some other issues as well. Not all nose concerns are amenable to liquid non-surgical rhinoplasty, but if you are among the lucky (or unlucky, depending upon how you look at it) ones whose nose can be improved with non-surgical treatment, the results are dramatic and instant, and are achieved without the pain and downtime of surgery. The in-office procedure takes about 20 minutes, and there is no need for anesthesia. Results are not permanent, however; they last between 1-2 years depending on the filler used.

The Traditional “Nose Job”

Rhinoplasty surgery (a “nose job”) and revision rhinoplasty surgery (second- or third-time surgery), can alter almost any aspect of the nose, and does so permanently. During surgery, a huge variety of techniques can be used to address the different parts of the nose.  Some common reasons people seek rhinoplasty include a crooked nose, wide (or “bulbous”) nasal tip, and dorsal nasal “hump”.

What Is Involved

In my practice, rhinoplasty surgery is performed under general anesthesia in an operating room. On average, the surgery usually takes between 2-3 hours, depending upon the particulars of the surgery. Surgery can be performed with incisions completely inside the nose (endonasal), or with a small incision on the outside of the nose, across the bottom (external). Choice of endonasal or external approach is based on the aesthetic goals of the surgery.

Recovery Time

Recovery from the surgery is not painful, but people look much worse than they feel during recovery. Most likely, you will want to give yourself 10 days or so before you rejoin society. After surgery, patients wear a small plastic cast on the bridge of the nose for one week. More often than not, the nasal bones need to be broken during surgery, which results in some nice shiners that stick around for 7-10 days. Swelling inside the nose, as well as stuffiness, are common for the first few weeks following surgery. You’ll look and feel pretty well after about 10 days to 2 weeks, but your nasal bones won’t be fully fixed into place for 6 weeks. Overall, healing from rhinoplasty is a gradual process: I advise people to expect to see 85% of the final result one month following surgery, 95% 6 months following surgery, and the final cosmetic result 1-2 years after surgery.

Functional Nose Surgery

A well-trained surgeon should be as interested in the function of your nose as the look of it, and should be well-trained to address both. Functional nose surgery may include septoplasty (straightening the wall between the left and right side of the nose), opening up the breathing passages, and/or reinforcing the walls of the nose to prevent collapse of the nose. Old school rhinoplasty was about cutting away bone and cartilage to make the nose smaller. This philosophy is what produced the pinched in, ski-sloped noses of old you can see on Madison Avenue. Modern rhinoplasty is as much about improving and maintaining the breathing function of the nose as it is the cosmetic look of the nose. Good nose jobs don’t look like nose jobs; they look natural, not plastic.

Now you know the nose basics.

A Note from Travel Beauty: As a trained ENT surgeon as well as a cosmetic surgeon, Dr. Dara Liotta is especially skilled in the art of rhinoplasty. Interested in learning more? Call or email her for a consultation: (212)288-2222.

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