Many patients come to my office with questions about a non surgical approach to nose reshaping (rhinoplasty). Nose reshaping is a complex operation. It requires both technical expertise and artistic skill to balance the nose in an aesthetically pleasing contour. Traditionally this has been done with cutting and using various tissues to graft or augment the nasal anatomy as needed. Recently, some new filler materials have become available that have shown some promise in achieving improvements to nasal appearance without cutting. The non surgical rhinoplasty usually involves injecting a filler material, usually a derivative of hyaluronic acid into the nose. Based on the placement of the material nasal shape may be improved. The benefits of this procedure are numerous. It is usually less costly than a traditional rhinoplasty. It can be frequently performed in an office setting without general anesthetic. The procedure is much quicker and may be less painful than traditional surgery. There is less downtime after the procedure, and patients frequently return to their normal activities right after the procedure. The material is not permanent, so if the result is not what the patient had hoped, it will eventually disappear. An injectable material to help dissolve the product is also available to immediately remove product if needed. There are limitations to the procedure. Not all patients are good candidates for this technique. If you have significant deformities or nasal obstruction, a traditional surgical approach may be the best option. If the material becomes infected, there is a risk of skin damage and loss over the nose which may be difficult if not impossible to correct. The procedure is new so no one has a ten year experience with the technique, some unexpected problems may arise in the future. Injecting the product into the nose may cause scarring in the nasal tissues making a subsequent surgical rhinoplasty more difficult. The non surgical nose job is a good procedure for some patients. It is best to discuss this with your nasal surgeon to find out if this is the right procedure for you.

Narrowing the bottom of the nose A frequent complaint in my office is that “my nose is too wide at the bottom”. The patient frequently refers to the nostrils (or more correctly the “nasal ala”) and wants these narrowed. This is possible with alar base reduction techniques. The first step is to determine if this procedure is indicated. The nose may be out of proportion due to a low dorsum, or disproportion of the nostrils with the other surrounding structures. The patient may require a different procedure to balance the nose and make the bottom of the nose “fit” with the face. If it is determined that the alar base is too wide, the next step is to determine the best method to narrow the base. There are a variety of procedures to narrow the base. Many different incisions may be used to place an incision in a place where it will be inconspicuous. However, all incisions leave scars. It is not possible to make an incision without leaving a scar. The skill involves placing the incision so the scar will be least visible. Only the most experienced surgeons in rhinoplasty should consider this procedure. The results can seriously deform a nose and after completion this is a difficult problem to correct. Alar base complications with complaints from patients having had this done is one of the commonest problems I see in the office. If not completed by someone with experience in this area the results can be very unsatisfactory. Frequently I counsel patients not to have this done since the initial diagnosis is not correct. Often a better solution to the aesthetic challenge the patient is facing will give them a result they will be happy with. Patient coming to my office after having this procedure looking for a revision are often unhappy to hear that I cannot improve the appearance. They will have to live with the result. All patients should be very careful in seeking to narrow the width of the nose with alar base incisions.

5 things that a rhinoplasty can change Rhinoplasty is the reshaping of the nose. It is a complex procedure and results can be variable. Experience and knowledge play an important role in consistently good rhinoplasty results. What are the things that a rhinoplasty can reliably change on your nose? My nose is too big The perception that a nose is too big is often incorrect. It may just be that the proportions are not balanced. “Make my nose smaller” is a common presenting statement for a patient. A rhinoplasty can “make your nose smaller”. This usually means readjusting the proportions of the nose for better balance. I have a large hump on my nose Nasal aesthetic surgery can remove bumps on the top of the nose. Dorsal irregularities are common and can be reliably improved with rhinoplasty. The surgeon must be very careful in patients with thin skin to smooth out all underlying irregularities to remove any bumps My tip is too wide A wide or boxy tip can be refined with a rhinoplasty. There are many tip refinement techniques that a modern rhinoplasty surgeon can employ to narrow the tip. Over-narrowing must be avoided; this may create a collapse of the tip supports and lead to cosmetic deformity and nasal obstruction. I have a twisted nose A curve to the entire nose is not uncommon. This can result from previous surgery, previous trauma or a natural phenomenon. This is something that is very hard to correct. The surgeon must always warn the patient that the curve may be improved but not eliminated. The methods to correct this may involve placing tissue on top of the curve or breaking the bones of the nose to reshape them. My nose is blocked Cosmetic nasal surgery always has a functional component. Unless the surgeon is skilled at surgery to improve the nasal airway this may not be appreciated. A person may have no nasal problems, but a cosmetic nasal procedure may alter the nose in such a way that a nasal obstruction results. If the surgeon is not aware of the nasal anatomy, they will not take the necessary steps to avoid this common post-op problem. All nasal surgery should preserve nasal function, maintaining breathing.