Category Archives: Non-Surgical Revision

Non-surgical Rhinoplasty – Permanently!

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"A lovely woman examines her nose with a magnifying glass"

Better Nose? Yours for Not Much $$

With an ever uncertain economy, more people are interested in all types of non-surgical cosmetic surgeries. Among men at least, rhinoplasty is the leading invasive procedure.

Unknown to most people, if you only need correction on the outside of the nose, a permanent non-surgical rhinoplasty may be right for you.  The only catch is, most cosmetic plastic surgeons use fillers like Juvederm or Radiesse that dissolve in six months to a year.

But in the United States, there are perhaps three to five plastic surgeons skilled in using permanent fillers like Silikon 1000 during non-surgical nose jobs.

Tons of RealSelf.com readers report on their cosmetic surgical experiences and the fees paid. The section on non-surgical rhinoplasty reports that 88 percent of those patients mark the procedure as “worth it.”

Typical of most such patients, Handle271 writes:  “After 2 rhinoplasties I was left with an over-resected bridge, giving my nose a pointy appearance. After two treatments of silicon (sic) injections about 3 months apart my nose looks 110% better. Well worth the it. No regrets, no downtime.” (Continued below)

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The patient below had marks on the outside of her nose due to a congenital malformation. Her nose was corrected without invasive surgery, using only a series of micro-droplet injections of silicone filler that delivered permanent, non-surgical rhinoplasty

"A lovely young woman shows her nose before and after injection rhinoplasty"

Left, before non-surgical rhinoplasty. Right, three months after procedure.

 

 

 

 

 

 

 

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(Continued from above) Penned Ruby23: “I’ve always been self-conscious about the bump I had in my nose. And always wanted to get a nose job but never really had the money. So The experience I had with the injections was pleasant – it was painless and fast and the doctor was very friendly. The results were visible the next day..”

Dana3262 had a first rhinoplasty that left a bump on one side and a dent on the other. She did not know about permanent injection rhinoplasty until her consultation with a Beverly Hills cosmetic plastic surgeon.

She writes: “Dr. K was able to even out the ridge so it doesn’t stand out quite as much and he filled in the dent making it even across my entire bridge. The procedure’s were quick, painless, permanent and I went back to work after each injection without any marks or bruising….This is the only surgeon who will ever touch my face again!”

Kiki2011 writes that she had flat, bumpy, “potato nose” and that she had been saving for a surgical rhinoplasty “…but from what I can tell, they usually cost over $5000 and I just wasn’t up for the recovery time.

“I just had Restylane injections in the bridge of my nose and it looks AMAZING. The entire bridge is more straight and defined..”

(Read more about the experiences of non-surgical rhinoplasty patients.)

Dr. Kotler: Ranked by MapQuest as #5 out of 500 medical & health professionals in Beverly Hills’ “Golden Triangle”

Nose Jobs and Your Skin

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"A beautiful woman with lovely blue eyes is shown in close-up"When you see a cosmetic plastic surgeon about a rhinoplasty, one of your most unlikely features – your skin — will be scrutinized. Why? Well, imagine it like this:

Think about building a carefully constructed model ship or airplane. You’ve labored long and hard to see perfection in every detail, right down to:

  • Spars,
  • Ailerons,
  • Rivets and all other features

Then you use, say, a section of thick rug to cover your delicately created model. What do you suppose your handiwork would look like? Wouldn’t be able to see much detail, huh? But what do you suppose would happen if you used shrink wrap instead? Why, you could see everything.

The same concept applies to your skin quality in a rhinoplasty. Very thick skin tends to mask while thin skin reveals much more of the structure of your carefully and artfully rejuvenated nose after bones, cartilage and other framework tissues that have been changed.

During healing – which can require months up to a year after surgery — your skin and the soft tissue overlaying the nasal skeleton contracts inwards and “shrink wraps” onto that carefully altered nasal framework. That’s one reason you don’t see what your actual nose will look like for some time. Also, swelling is present after surgery, masking the true, eventual look of your rhinoplasty.

Thin skin shows the new nose in all its glory but any irregularities also show. Some people have such thin skin that some medical “padding” is added in surgery.

People with thicker skin may even have the fat layer under their nasal skin reduced somewhat by the plastic surgeon.

Thicker skin is especially important in ethnic rhinoplasty. Such noses can be harder to refine at the tip and have a tendency to retain fluid. This complication is especially common in patients of the following backgrounds:

  • African-American
  • Hispanic
  • Middle Eastern
  • Mediterrian

Another good option if you’re not happy with what shows through your nose skin: non-surgical rhinoplasty. Provided you only require work on the nose’s outside, many excellent facial fillers can be used if want a temporary filler first.

Later, go to permanent filler.

(Read more about permanent, non-surgical rhinoplasty revision, also known as injection rhinoplasty.)

It’s safe, predictable and cost far less than a surgical revision.

(In the photos below, from left: The patient had an unsuccessful rhinoplasty elsewhere. The after picture, right, shows the result of permanent, non-surgical rhinoplasty revision with fillers only, without any invasive surgery.)

"A woman's nose is shown in close-up before and after injection rhinoplasty"

Non-surgical revision rhinoplasty

Non-surgical Nose Jobs: Top Ten Reasons for Proceeding

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"A pretty young woman is examined by two doctors"

A Little More Here, Please

With so many L.A. rhinoplasty surgeons, some wonder why a nose job patient would skip a nose job and get a better looking nose via non-surgical rhinoplasty means.

  • Cost

Most can quickly relate to purse or wallet contents. A non-surgical rhinoplasty costs a fraction of the surgery.

  • The surgeon’s office

No surgeon’s assistants, nurses or anesthesiologist are needed — the entire procedure can be done in the office. So you skip charges for the operatory and the anesthesiologist’s fee. Plus, there’s no need to hang around in recovery, waiting to go home. Leave in ten to 15 minutes, just as soon as the injections are done.

  • WYSIWYG (What you see is what you get.)

You don’t have to rely on before and after rhinoplasty pictures of other patients. Plus, with surgery, there’s no accounting for Mother Nature when cartilage, bone, fat and other tissue is transplanted or surgically grafted onto a nose. In non-surgical rhinoplasty, the doctor can give you a picture what your nose will look like by using sterile salt water to fill in bad spots or hide bumps on the nose. Salt water lasts a minute before dissolving back into the body. But it’s enough time to snap a picture.

  • Go back to work afterwards

So you can go back to work, home, the gym or wherever you want with no signs of facial swelling, bruising or other tell-tale surgical signs.

  • Join in!

Take part by watching in a hand mirror. If you want changes, ask the doctor to place more, use less or say whoa, enough!

  • No painful needle jab

Afraid of needles? Don’t be – an anesthetic cream is spread on your nose first.

  • Previous nose job? O.K.!

If you have had no previous nose surgery or if you have gone through a repeat “rescue” rhinoplasty to repair a badly done nose, you can still have non-surgical rhinoplasty.

  • Temp or permanent?

You’ve got choices, too. Want the fillers Juvederm, Restylane, collagen or Sculptra? O.K., but those are absorbed in anywhere from three months to one year. If you’re hankering for permanence, ask for Artefill or Silikon 1000.

  • Do it after surgery

Say you have surgical rhinoplasty to improve breathing and then find there are still a few nasal marks, hollows or gouges. Forget going under the knife again and use non-surgical rhinoplasty for a cosmetic repair.

  • Less is more

Doctors like progressing a little at a time. Non-surgical rhinoplasty is completed when the injections are given about 45 days apart. So the surgeon injects a small amount and then waits to see if more is needed.

"A before and after picture shows permanent, non-surgical rhinoplasty on a young man"

Patient had bad surgery elsewhere. After: permanent, non-surgical rhinoplasty

Bad Plastic Surgery: Finding A Better Fix

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"A smiling young couple do a computer search"

Searching for Surgeons

The stories of bad plastic surgery seem to always have a common beginning; either somebody does not like the appearance of his or her nose or needs internal nasal surgery to:

  • Fix a once broken nose
  • Repair a deviated septum
  • Reduce turbinates

But then, things go wrong. Patients often quickly choose the closest plastic surgeon, the doctor who charges the least or the cosmetic surgeons they heard about through Aunt Sally’s boyfriend’s cousin.

However, a recent patient, 34-year-old J.G., at least made a stab at researching a qualified, trained, certified and experienced nasal surgeon near his Texas home to correct his deviated septum.

Although the Texas surgeon that J.G. found and used is:

  • A book author
  • Won awards for his work
  • Was well respected in his medical community

the procedure did not turn out well at all and made J.G’s breathing even worse. A deviated septum that twists and turns inside the nose creates additional blockages to healthy breathing.

J.G. then widened his search for nasal surgeons worldwide to correct the damage  before landing in our Beverly Hills office. (Read more functional and cosmetic surgery patient stories.)

Finding corrective, or revision nasal surgery, requires much more research than finding a good surgeon for a first nose job.

Why? Revision nasal surgery is so much harder for many cosmetic plastic surgeons who routinely turn out first rhinoplasties day after day, they shy away from corrective surgery.

His corrective surgery went well with the breathing problem normalized.

Then, J.G. found that marks on the outside of his nose could be corrected without yet another trip to the operating room. He opted for permanent nonsurgical rhinoplasty which involves a series of quick injections in the office, separated by ten to 12 weeks.

(Read more about “Rescue” rhinoplasty, another moniker for permanent, nonsurgical rhinoplasty.)

So, for a while, J.G. traveled from his Texas home to Beverly Hills every three months to complete a corrective, non-surgical rhinoplasty that yielded a handsome nose which flattered his profile.

He then capped off his visits by having neck sculpture and was a very happy camper indeed.

Permanent non-surgical rhinoplasty?

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"A lovely woman closes her eyes as a needle approaches her nose"

Injection Rhinoplasty

Quite a few rhinoplasty surgeons offer non-surgical (or injection) rhinoplasty. But does it last?

Facial fillers like Sculptra, Radiesse, Juvederm and Restylane are often used. But they dissolve back into the body within six months to a year. That means more trips back for additional injections and more time lost from work.

But, permanent injectable fillers last as long as you do. To date, there are only two for the face:

  • Artefill
  • Silikon 1000

While Artefill is intended for the deep creases, lines and age-revealing folds in the face, Silikon 1000 is used for permanent nose jobs done by injection. And that’s only if you need correction on the outside of the nose.

With Silikon, you can get a preview of coming attractions.

If you have divots, marks, scars, pocks, a nasal hump, a low bridge or other marks on the surface skin of the nose, only a few U.S. rhinoplasty specialists offer Silikon 1000 corrections. The very best surgeons can show you what your nose will look afterwards by using sterilized saline – plain old salt water – to reveal what the Silikon 1000 injections will do for your nose.

Saline improvements last perhaps an hour, long enough to snap a few pictures. Compare the saline test shots with pictures showing the nose in its natural, unrepaired state and then decide if you want to make it permanent.

Silikon 1000, a medical grade silicone, is used in internal eye surgery. A standard, approved and legal part of any medical practice – including those of cosmetic plastic surgeons – is using a substance or technique “off-label”.

Meaning? While the substance has not been tested by the FDA for that particular use, it is the best treatment available to the doctor who has seen it work in many patients.

Some history:  Silikon 1000 for injection rhinoplasty has been used successfully in nasal skin improvements for the last 50 years. According to scientific literature, the secret is placing tiny micro droplets just under the skin to plump out and disguise hollow places.

(Read more about permanent, non-surgical rhinoplasty in Plastic and Reconstructive Surgery, a professional magazine for plastic surgeons.)

For instance, a nose with a large hump can be made to look straight again using no more than 1/8th of a teaspoon of Silikon 1000 injected at many different locations on the nose.

The body walls off the tiny micro-droplets, creating a plumping action that fills in humps, scars, lines and other marks on the nose.

"A very pretty young woman shows her nose before and after injection rhinoplasty"

Before and After Non-surgical Rhinoplasty

The woman’s nose, left, caved in from a failed surgical rhinoplasty done elsewhere. Right, the results of permanent non-surgical injection rhinoplasty. No further surgery needed.

Face Lift and Fat Transfer

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"A man holds his bulging belly which falls over his belt"

Fat? A Facial Filler?

In cosmetic plastic surgery, fads come and go.

One of the most widely discussed now is fat transfer. At first, it sounds like the perfect solution: take fat from where you don’t want it and put it where it makes you look younger.

But you know the old saw: “If it sounds too good to be true — it usually is!”

Known alternately as fat grafting, fat injecting, autologous fat transfer, (and medically, platelet injection fat transfer) some patients ask for fat injecting to:

  • Fill sunken places below the eyes
  • Plump skin creases known as nasolabial folds, the deep wrinkles running from the corner of the nose to the mouth’s edge
  • Mask deep forehead lines
  • Build out sunken cheeks
  • Disguise “Marionette lines” running from the corners of the mouth down the chin

Only problem: fat injections can be unpredictable. The whole process depends on injected fat finding a blood supply. Otherwise, it withers and dies.

Fat can also grow beyond the correction you seek. And if you don’t like it, you’re stuck; it can’t be removed.

Everything a facial plastic surgeon does must result in balance. For instance, if we injected the same amounts of fat into each cheek, we could not be sure of facial balance. One cheek may yield plumpness while the other becomes hollow.

Another consideration: due to Mother Nature, fat injecting works better on younger patients while those really need face lifts are older.

Nonetheless, it’s the older patients who need the padding just beneath their facial skin. Much of aging’s effects are caused by facial fat loss, resulting in those wrinkles, folds and deep lines.

Meanwhile, we already have excellent products that perform that same function. Grouped together, they are known as facial fillers.

Of course, most are not very long lasting. While we have seen some cases of Sculptra lasting half a decade, (and Artefill being permanent,) the others last four to six months, including:

  • Restylane
  • Juvederm
  • Radiesse

The other advantage with facial fillers: doctor and patient can immediately see the results. (It takes a few months for Sculptra to take effect.)

Another consideration: fat injection done properly takes incredible skill. One leading cosmetic plastic surgeon discovered that a teaspoon of the patient’s own fat injected near muscles is too big to find a blood supply.

However, fat droplets the size of a pea stand a better chance.

(Look at some face lift before and after pictures – not done with fat transfer)

PLASTIC SURGERY BUSINESS ON THE RISE

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 Recently, a press release from one of the plastic surgery trade organizations reported that there was an increase in activity in the plastic surgery community.  That was said to be harbinger of better economic times to come. 

Frankly, I am not so sure of that.  The growth in cosmetic procedures is not in the surgical arena.  It is in the non-surgical office treatment arena.  So, as I see it, the increase in the “ plastic surgery business” is not in the plastic surgery but in the syringe and needle department.

Botox Cosmetic, Dysport, Restylane, Juvederm, Sculptra, and Radiesse, Artifill and medical-grade liquid silicone are all good and valuable treatments that patients are flocking to. 

We cosmetic surgeons are glad to have these excellent products available to us, but the reality is, alone, they cannot do the job.

Today’s patients, watching their budgets, are apt to opt for the non-surgical treatments before the more major treatments, such as face and neck lift, neck sculpture, upper and lower eyelid surgery, brow lift, chemical skin peel, or laser skin treatments.  It is understandable. Office treatments require no time off, are virtually painless, and are far less expensive. 

It may be that we never reach the numbers of surgical procedures that were done before the current Great Recession.  While the cutting and sewing procedures are available for patients, the utilization may be less because of economics, primarily.  Understanding that, many practices are offering reasonable discounts to aid people who might otherwise not be able to afford the procedures.

When consulting with doctors, be sure to ask about all treatments available, both surgical and non-surgical. And, ask how you can shave some dollars from the cost without sacrificing quality.

I have some hints on that for you on a future blog post.