If you have esthetic concerns about your nose but are not sure if you are ready for surgery, non-surgical rhinoplasty may be an appropriate alternative for you, but it is important to understand the differences between surgical enhancement (rhinoplasty) and non-surgical treatment.

Dr. Steven Goldman is one of a handful of facial plastic surgeons who is Triple Board Certified (certified in Facial Plastic Surgery, Plastic Surgery, and Otolaryngology/Head and Neck Surgery). He is an expert in both surgical and non-surgical rhinoplasty. He understands that being well-informed is critical for any patient considering these techniques.

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What is nonsurgical rhinoplasty?

Nonsurgical rhinoplasty is a medical procedure in which the shape of the nose is altered using injectable fillers like Restylane or Radiesse.

Nonsurgical rhinoplasty (also known as a liquid nose job) is an advanced form of facial filler injection. Initially used just to treat wrinkles, experienced doctors now commonly use fillers to enhance facial contours and proportion. Fillers can, in small precise amounts, be injected into the nose to temporarily correct esthetic imperfections.

When injected with finesse and precision, fillers can camouflage a hump on the bridge of the nose, make the nasal tip look narrower or more well-rotated, or correct other deficits, like asymmetry.

The primary advantage of the liquid rhinoplasty technique is that it involves little to no downtime. Most patients have no bruising and minimal swelling. The procedure takes just a few minutes. Cost is less than for a rhinoplasty, but when nonsurgical rhinoplasty is repeated multiple times over several years, costs can actually exceed that of rhinoplasty surgery.

The two main disadvantages of non-surgical rhinoplasty compared to surgery are that the changes are not permanent and, therefore, have to be repeated over time, and volume can be added to the nose to hide imperfections, but the nose cannot be made to look smaller in any way, since no tissue is reduced, whereas surgical rhinoplasty can actually make a nose smaller in many cases.

The goals of nonsurgical rhinoplasty

Non-surgical nose jobs can be used to:

  • Smooth or camouflage a hump on the bridge of the nose (a “dorsal hump”).
  • Make the nasal tip look narrower.
  • Create the impression that the nasal tip has been rotated upward to correct droop.
  • Fill or minimize some asymmetries to create a balanced appearance.
  • Correct depressions or contour irregularities.

Who’s not a good candidate for nonsurgical rhinoplasty?

Nonsurgical rhinoplasty procedures do not treat any breathing issues with the nose, so any patients who need correction of nasal breathing issues due to a septal deviation or other causes will need surgery.

Patients who want a permanent esthetic correction need to consider surgery since there are no permanent filler options for the nose.

Patients who have large, prominent dorsal humps on the nasal bridge generally prefer a surgical reduction to lower this versus creating the look of a very high bridge with filler. This decision varies based on the patient’s goals and overall facial esthetics.

Patients with markedly drooping nasal tips also often prefer the more definitive correction of cosmetic surgery versus mimicking rotation with filler.

How does this nonsurgical rhinoplasty work?

Fillers add volume wherever they are injected. When the filler is injected just above a bump on the bridge of the nose, it will reduce the appearance of the bump or even eliminate it in some patients. When the filler is injected properly into the tip, it will make it look elevated and refined.

The tip may look smaller and less bulbous even though filler has been added to it. Depressions or asymmetric areas can also be filled and smoothed.

Dr. Goldman uses Restylane and Radiesse for most of his Cleveland nonsurgical rhinoplasty patients. Restylane and most other fillers are made of hyaluronic acid, a chemical found in human skin and joint fluid that attracts and binds moisture, plumping up the skin to fill wrinkles and creases in the face or to recontour the nose.

The hyaluronic acid used for fillers is purified from bacteria (not taken from humans) and has no bacterial proteins. Radiesse is calcium hydroxyapatite, a building block of bone. Radiesse tends to be firmer than hyaluronic acid and lasts longer in most patients.

What to expect before nonsurgical rhinoplasty

Dr. Goldman will prepare you for the procedure by inquiring about your expectations and goals. He’ll ask if you have pre-existing health conditions or factors that might contraindicate the procedure. After a thorough examination, photography, and facial analysis, Dr. Goldman will discuss potential options and recommend a customized treatment plan for you. Typical outcomes, recovery, and potential risks are reviewed.

What to expect during the procedure

Like most filler injections, a non-surgical nose job is an office procedure that requires no anesthesia. Most patients do not even need topical anesthetic. The filler of choice is injected in a precise, artistic fashion. The injection itself generally takes about 5 minutes.

What to expect after non-surgical rhinoplasty

Most patients see minimal or no bruising. Swelling is generally minimal and not noticeable to others, but because this is a precise, small volume injection, swelling can obscure the final result for 1-2 weeks.

Almost all patients return to work the next day. A small percentage of patients (perhaps 10% in our practice) will have more significant bruising that requires cover-up makeup. Such bruises can take 2-3 weeks to resolve, like a bruise from any cause. Patients can work out the day after a non-surgical nose job.

Is liquid rhinoplasty safe?

In the hands of a skilled, experienced injector, liquid rhinoplasty is safe with very high satisfaction rates. As with all filler injections, however, there are rare instances of filler getting into one of the tiny arteries of the face.

Filler can then block blood flow within these tiny arteries, causing skin necrosis (a patch of skin can die, scab over, and scar) or blindness if filler travels to the retina of the eye. Even though these risks are very rare, all filler patients should be aware of them.

Other risks of using dermal fillers like Radiesse and Restylane include asymmetry, lumpiness or nodularity, and bruising. It is also important to remember that with all surgical and non-surgical procedures, results vary; there are no guaranteed results.

Dr. Goldman prefers to be conservative at the first injection because filler always adds volume to the nose. More filler can be added at a second setting to achieve an even more dramatic result once the patient is comfortable with the technique and its effects.

Why choose Cleveland, Ohio, nose surgeon Dr. Goldman?

Dr. Goldman is one of the few Triple Board Certified plastic surgeons and facial plastic surgeons in the country. He also has a special interest and extensive experience with rhinoplasty and injectable fillers. He was one of the first plastic surgeons in Cleveland, Ohio, to utilize this technique for the nose.

Given his facility and experience with both surgical and non-surgical techniques, he can help you determine which is best for you. If you have any questions about nonsurgical nose jobs, please contact us at info@drgoldman.com.