Injectable Rhinoplasty: When, Why and Why Not
Injectable Rhinoplasty: When, Why and Why Not
With the desire for non-invasive techniques today, many patients are turning to injectable rhinoplasty to make themselves feel better about their nose shape without undergoing surgical rhinoplasty. However, is this a good thing? Who is a good candidate?
First, let’s define what injectable rhinoplasty is. It involves injecting the nose with a temporary or permanent filler like Restylane or silicone, respectively, to make the nose shape appear more attractive. This is particularly appealing because minus the risk of bruising and slight swelling, there is almost no downtime to this procedure and the patient walks out of the office with an immediate result. Also, the physician can fine tune the procedure almost better than a surgical rhinoplasty all the while injecting minute amounts of filler until the right contour develops.
Although injectable rhinoplasty is very alluring it is not for everyone. Here are some of the limitations. First, injectable rhinoplasty is a bad idea for someone who is seriously considering surgical rhinoplasty. Having product injected into the nose, especially repeatedly, can lead to tissue distortion and decreased blood supply that may make surgical rhinoplasty more difficult or even dangerous. Any patient who wants to “try on” a rhinoplasty probably should not be doing this with a filler if at all possible. If the patient insists, then injecting the nose with some salt water (saline) may be a workaround solution. However, a surgical rhinoplasty really does not look like an injectable rhinoplasty, and it is important that a patient understand this difference.
This patient underwent injection of Restylane into her radix (the top of the nose) in order to soften the appearance of her nasal hump.
Where else does injectable rhinoplasty not work well? In short, in the nasal tip. The bridge of the nose expands very well to accommodate injectable products but the tip hardly expands making injections here very difficult. The only exception that I have found in which injectable rhinoplasty may help in the nasal tip is to fix small defects after surgical rhinoplasty such as a small depression or slight notching of the nostril.
In the bridge of the nose, if there is a very large bump that a person wants to cover up by placing product in the top portion of the bridge known as the radix, this will oftentimes fail. However, for a small bump on the nose, placing modest amount of product in the radix can camouflage the bump very well and avoid a surgical rhinoplasty if that is what the individual is seeking. The other caveat is that a person should have a moderate nasofrontal angle or at least not a shallow one, i.e., the angle between the forehead bone and the nose should not be so shallow that injecting product in this area wipes out that indentation, which can look unnatural.
In Asian noses, injectable rhinoplasty can work to raise the bridge. However, many times the Asian nasal tip is so short, that when the nose bridge is injected the nasal tip can look even shorter and thereby more unbalanced. A consultation with a physician that has a good aesthetic eye should be the prerequisite to determining one’s candidacy for this procedure.
Finally, where I love injectable rhinoplasty is for someone who has had a bad rhinoplasty and who is left with a small dent here or there on the nose. I believe that by trying to put another structural cartilage graft under the thinned out skin will only in time lead to another visible bump as the cartilage shows up over time. My feeling is that a shrink-wrapped nose that can develop years after a surgical rhinoplasty needs a thicker soft-tissue/skin envelope that a revision rhinoplasty simply will not fix (but may worsen). In these select cases, I prefer silicone micro droplets to thicken the skin envelope and thereby cover any minor or even major skin deficits. Again, this should only be carried out if the person is not considering a formal, surgical revision rhinoplasty.
A combination of understanding safety and aesthetics is very important for any physician who practices injectable rhinoplasty. Unfortunately, many who perform injectable rhinoplasty are not surgeons and that is their only tool; and “if all you have is a hammer, everything looks like a nail.” Hasty injectable rhinoplasty can then make surgical rhinoplasty, which may be the more desirable or correct option, less safe in the future.