An alternative to surgical revision of the nose is what is called the “nonsurgical rhinoplasty” or “liquid rhinoplasty”. This procedure involves the injection of dermal filers such as Restylane, Perlane, Juvederm Ultra, Juvederm Ultra Plus, Radiesse or Artefill in the nose to change its shape. The choice of which filler to use is based on the specific properties and duration of results of each filler as well as the desire for a temporary or permanent correction.
Fillers in the nose can be placed to fill indentations, raise the height of the bridge if it is lowered too far, create symmetry if the nose is crooked or asymmetric, hide a hump by filling in front of and behind it, and lift the tip if it is droopy. Because fillers are adding volume to the nose, there is no nonsurgical way to reduce the size of a nose. However, in some cases fillers can be used to create this effect, causing the nose to blend in better with the other features.
The hyaluronic acid fillers (Perlane, Restylane, and Juvederm) have the advantage of reversibility with the injection of an enzyme called hyaluronidase, which dissolves the filler within minutes. There is also very little scarring and adhesion formation underneath the skin with these products, in case patients decide to later pursue surgical correction. Radiesse is also commonly used but there is no option to reverse this product. Instead, it gradually dissolves over 12-18 months following injection. There is more adhesion formation between the cartilage and skin with Radiesse which makes surgery a bit more complicated and time-consuming later.
In all cases, the nonsurgical rhinoplasty can be done very comfortably in the office. A topical lidocane cream is applied to partially numb the skin. The fillers also contain lidocaine so each injection hurts less and less. Anywhere from 0.2 mL to a full 1.0 mL syringe may be needed, depending on the degree of augmentation desired.
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