Esthetic changes can be achieved in minutes in the office setting, avoiding costs and recovery associated with surgery, and satisfaction rates for non-surgical rhinoplasty are high, but the changes are not permanent.

Nonsurgical rhinoplasty is not permanent. It involves injecting fillers into the nasal skin to camouflage concerns like a hump on the bridge of the nose. Fillers are not permanent and cannot make the nose smaller, so results are more subtle than surgery. Nonetheless, satisfaction rates are high.

Prospective patients considering rhinoplasty (surgical refinement of the nose) will often come across information about non-surgical rhinoplasty as they research options for the nose. As with Botox™ and fillers versus facial rejuvenation surgery, there are some important differences between non-surgical and surgical options that the informed patients should understand before undergoing either treatment.

Non-surgical rhinoplasty (NSR) is simply the placement of injectable fillers (like Restylane™ or Radiesse™) into the nose to augment, fill, add volume to specific areas to camouflage irregularities or otherwise enhance appearance. Esthetic changes can be achieved in minutes in the office setting, avoiding the anesthesia, costs, and recovery associated with surgery. Satisfaction rates for non-surgical rhinoplasty are high, but the changes are not permanent. Like most non-surgical treatments, downtime is generally minimal. Patients may have noticeable swelling or bruising, but most will return to work and exercise the same day or the day after NSR.

NSR is an alternative to surgery but is not equivalent. Filler injection can only add volume and therefore cannot make the nose any smaller, nor can filler reposition nasal structures, like lifting up a drooping nasal tip. And, as noted, results are not permanent, so the procedure must be repeated over time. Of course, the ability to make esthetic changes to the nose literally in minutes, in the office setting with minimal recovery time, means that NSR is a powerful alternative to surgery in appropriately selected patients.

Both NSR and surgical rhinoplasty require extensive skill and experience on the part of the injector or surgeon and are generally considered more complex than other facial injections or surgical procedures.

Compared to Surgery, What are the Advantages of Non-surgical Rhinoplasty?

As mentioned above, the main advantage of NSR is that it can be performed in the office, without anesthesia, and with minimal downtime. This is, of course, the main advantage of all non-surgical treatments. In addition, the up-front costs of NSR are less than with a surgical procedure, although repeated treatments over time can add up to greater costs than surgical rhinoplasty.

Another real benefit of NSR is that patients can see how it feels to alter their appearance without committing to a permanent change. This can be useful for patients who are ambivalent, who are not yet sure if they want rhinoplasty. However, patients do need to understand that NSR and rhinoplasty do not produce the same results, the same look, as explained below.

What are the Disadvantages of Non-surgical Rhinoplasty Compared to Surgery?

There are two main disadvantages of NSR compared to surgery, which were mentioned above. First, NSR is not permanent, although the results do usually last for several months. Second, volume can only be added to the nose with filler, not taken away. Fundamentally, this is a procedure of camouflage. Irregularities can be smoothed out; asymmetries can be minimized; a hump on the bridge of the nose can be partially hidden by filling around it.

Paradoxically, a nose may actually look smaller if a hump or other esthetic imperfections are minimized, and patients are generally thrilled when an esthetic feature that bothered them is deemphasized, is hidden. But the nose cannot be made smaller, and most patients ultimately want some size reduction if they seek surgical rhinoplasty.

What Kinds of Esthetic Changes are Typically Achieved with a Non-surgical Rhinoplasty?

As mentioned above, fillers can only add volume to the nose, but this can nonetheless dramatically enhance nasal proportions. Perhaps the most common maneuver for an NSR is camouflaging or minimizing a dorsal hump (a bump on the bridge of the nose) which is accomplished by raising the level of the skin above, and usually below, the hump.

The second most common maneuver is changing the proportions of the nasal tip to create the appearance of more tip rotation, as if the tip has been pushed upward to a more youthful, feminine (when appropriate) position. Filler is also commonly used to contour the nostrils, camouflage irregularities, and minimize asymmetries.

Enhancement of the lips or augmentation of the chin with filler does not technically constitute NSR but are often useful in a comprehensive, holistic refinement of nasal proportions. This is also accomplished with fillers, but not necessarily the same type of filler used for the accompanying NSR.

What are the Risks of Non-surgical Rhinoplasty?

As with all injectable fillers placed in the face, there are slight but real risks of skin necrosis and blindness. Skin necrosis is when a patch of skin dies. These events are caused when filler gets into a tiny blood vessel, blocking the vessel and therefore blood flow, in essence causing a tiny, focal stroke.

Any patient who has an injection with Restylane™, Juvederm™, or any other filler in any part of their face has had these risks. They are rare, but any injection patient should be aware of them; the only way to avoid them is not to have a filler injection.

Bruising and swelling are not uncommon after any facial injection and can be significant enough to be noticeable to others. And as with any esthetic procedure, patients may not be happy with the result. Nodularity (bumpiness) or delayed swelling may occur.

Once the filler is injected, patients generally have to wait 6 to 12 months before they can have a surgical rhinoplasty. If you decide after NSR that you want to proceed to surgery, you generally have to wait several months, although some fillers can be dissolved.

How Long do the Results Last and are There any Disadvantages to Repeat Treatments?

As with any filler injection, the longevity of the result is variable from patient to patient and injection to injection. The average for NSR is about 6 months, but many patients feel their results last longer. And although NSR can be repeated over time, the filler will eventually cause some fibrosis (scar tissue) in many patients, which can make surgical treatment more complex. In general, patients will proceed to a surgical rhinoplasty after a few non-surgical treatments.

Of note, this is the one type of filler injection for which Dr. Goldman has patients return 3 weeks or so later to have a possible touch-up injection.

For other filler injections, this is not necessary or routine, but for NSR, even a fraction of a millimeter of change can have a significant effect, so a touch-up injection may be useful.

Which Fillers are used for Non-surgical Rhinoplasty?

Restylane™, Radiesse™, and Juvederm™ are probably the fillers used most commonly for NSR. Restylane™ and Juvederm™ are made of hyaluronic acid, a naturally occurring chemical prevalent in our skin and joint fluid that binds water. It helps maintain hydration and plumpness to the skin and lubrication in the joints.

Hyaluronic acid is well tolerated by the body and generally produces a soft, natural result. One advantage of this type of filler is that it can be dissolved with the enzyme hyaluronidase, although this is rarely necessary.

Radiesse™ is made from hydroxyapatite, a calcium compound prevalent in our bones. This is thicker than hyaluronic acid fillers and, therefore, may be more useful in patients with thick skin. It may last longer than Restylane™ in some patients. One disadvantage is that it cannot easily be dissolved, so patients who want to proceed with surgery may have to wait longer than those who have had Restylane™ or Juvederm™.

What is the Downtime from Non-surgical Rhinoplasty?

As noted above, most patients return to work and exercise the day after the procedure or the same day. Perhaps 10% of patients may experience noticeable bruising, although makeup (and masks) can often conceal bruising. Swelling is minimal.

Who is a Good Candidate for Non-surgical Rhinoplasty?

As with surgical rhinoplasty, good candidates have specific concerns that are amenable to correction and have realistic goals and expectations. Surgical and non-surgical treatments must always be customized for you and your specific physical characteristics and goals.

Plastic surgery is never cookie-cutter; it is individualized for you. Make sure you see a qualified, experienced, board-certified surgeon who takes the time to understand your goals, carefully analyze your face and thoroughly explain all treatment options to help you make the best choice for you.