Fix that hooked nose with a nonsurgical ‘nose job’

April 17, 2014 by
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nose_jobIn recent years there has been a trend away from surgical rhinoplasty, the medical term for a “nose job.” Some people might not be able to afford the surgery or two-week recuperation, or can’t bear the thought of a long, painful recovery.

Today, many impressive improvements can be obtained through nonsurgical means, using soft-tissue volumizing filler materials. Intranasal surgery remains the treatment of choice for inner problems such as a deviated nasal septum. But surface problems such as a bent or beak-shaped nose, a droopy or hooked tip, bumps, nasal clefts or depressions all can be treated with minimally invasive, nonsurgical procedures.

Dermatologic surgeons have quite a few injectables available for use in nonsurgical nose jobs. I routinely use Radiesse, Voluma and Perlane L in my practice. All three are FDA-approved, and the safety of each has been well established here in the U.S. as well as in other parts of the world, where they were available long before their introduction here.

Treatments depend on conditions: The precise combinations of materials chosen will depend upon the specific types of irregularities being addressed. For example, I could inject Radiesse, a calcium-based product, to supply support to overlying tissue while using hyaluronic acid soft-tissue to achieve more superficial, finer shaping.

A drooping nasal tip is a very common occurrence with aging or following pregnancy. Tiny droplets of a neuromodulator (e.g., Botox, Dysport or Xeomin) are injected directly into the crevices on each side of the nose and to the base where it joins the upper lip. This gently weakens those muscles responsible for pulling the nose downward and permits the small muscles higher up to draw the tip upward unopposed.

The net result is that the tip is repositioned for a more youthful appearance. Next, a small amount of volumizer placed along the nose’s base serves to buttress the tip upward and reinforce the effects of the neuromodulators. This contributes to a much longer lasting result than would be achieved with the neuromodulator alone.

To smooth a bump or hump on the bridge of the nose, Radiesse combined with Perlane L is my augmenting combo of first choice. A tiny amount layered between the nose bridge and root can straighten a bent or hooked appearance with immediate and often dramatic improvement. The before-and-after photos shown here were taken just 10 minutes apart.

The procedure: The procedure for nonsurgical rhinoplasty is quite straightforward. The area to be treated is injected with a fast-acting local anesthetic for numbing plus a blood vessel constrictor, which helps reduce the likelihood of bruising afterward. Once the area is numb the volumizer or filler is injected and then molded like clay into place to correct the particular irregularity.

The entire process typically takes about five minutes. In most cases, the result is immediate and prompts a “Wow!” when the patient looks in the mirror. After the procedure, there may be some redness, mild swelling and tenderness, which may last from one to three days. Occasionally there might be some bruising that can take several days to fade but is easily disguised with makeup.

Results may last from 12 to 18 months, and sometimes even longer. After this time, a touch-up may be all that is necessary.


Nelson Lee Novick, MD, is a Clinical Professor of Dermatology at the Icahn School of Medicine at Mount Sinai in New York City and an Attending Physician. He is a Fellow of the American Society for Dermatologic Surgery, American Academy of Cosmetic Surgery and the American Academy of Dermatology. He also maintains private practices devoted to cosmetic dermatology and cosmetic dermatologic surgery in Manhattan and in Israel. He is the author of nine trade books, including You Can Look Younger at Any Age.

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