Grade Surgical

Grade Surgical

Non Surgical Nose Job

Correcting cosmetic nasal defects with Radiesse results in a high level of patient

Satisfaction and gives surgeons an option for patients not ready for rhinoplasty.

Until recently the only option open to patients who wanted to improve the appearance of their nose was surgical rhinoplasty, a procedure that requires general anesthesia or intravenous sedation, up to two weeks of downtime, significant postoperative pain and substantial expense. The full results of the surgery might not be completely known for several months, and surgical risks include scaring, infection and anesthesia complications. For patients with cosmetic nasal defects such as bumps, bulges, dents and asymmetry, it isn't surprising that making the decisions to have rhinoplasty can be difficult. Now surgeons have an option that offers patients immediate, if temporary, relief from many of these bothersome nasal imperfections for less than $1,000.Seeing the results of this temporary solution can help some patients make up their mind to invest in the long-term surgical solution and offers others the ongoing option of correcting the defect on their own schedule when it fits their needs.

Patient Selection and Preparation

The nonsurgical nose job produces an extremely high degree of patient satisfaction. Patients find it hard to believe that with just 15 minutes of virtually painless, side wall or tip, surgeons can recontour the nose to address many of their dislikes about its appearance. While nonsurgical correction cannot decrease the size of a large nose or change the shape of the nostrils, it is ideal for patients with bumps or dents, sideways deviations or a droopy tip in those who are not emotionally or physically ready for surgery. Fillers can even be used to refine problems that persist after rhinoplasty, although patients with multiple rhinoplasties may be at risk for skin necrosis due to changes in blood supply related to surgical manipulation.

Just prior to the procedure, surgeons apply a topical mix of 60% lidocane/6% tetracaine to minimize pain. Injection sites are marked and the area is thoroughly cleansed with alcohol pads.

Procedure

Preferred filler for nose jobs is Radiesse (BioForm Medical), FDA-approved dermal filler consisting of microspheres of calcium hydroxylapatite (CaHa) suspended in a carboxy-methylcellulose gel. It is ideal for this procedure for several reasons:

• Correction with Radiesse lasts longer than correction with hyaluronic acid (HA) fillers-6 to 10 months with CaHa compared to 3 to 6 months with HA.

• It provides more volume compared to Ha fillers; small amounts of Radiesse can result in great differences.

DETAILS

• Calcium hydroxylapatite , a mineral found in bones and teeth, matches the consistency of the better than other dermal fillers.

• Radiesse is a paste-like substance, which molds easily and is less likely to migrate compared to HA fillers, especially in an area like the nose where the filler may be under pressure due to the limited capacity of the nasal skin to expand. The procedure typically takes 15 minutes or less. Using a 27-guage, half-inch needle, Surgeons inject the filler into the subcutaneous tissues or super-periosteal plane and then mold it into shape. The amount of filler used ranges from 0.1cc to 0.5cc, based on the type of deformity. Nasal bridge construction on Asian or African American noses can require up to 1.0cc of Radiesse.

Surgeons apply ice immediately following the injections. Patients report little or no discomfort during the procedure.

Expected Results

Although there is no downtime and patients can return to work and general activities immediately, the nose can be slightly red and swollen, and the injection sites may be slightly sore for a day or two. There is a risk for skin necrosis as there is with any type of injection. I ask patients not to touch the area for a week, not to wear glasses (including sunglasses) and to forgo contact sports for a week. Patients are instructed to return for follow-up in two weeks.

There are no lasting side effects with this procedure, and the level of patient satisfaction is extremely high. The nonsurgical nose job is a simple, minimally invasive technique for patients who are interested in improving the appearance of their nose without undergoing rhinoplasty.

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About the Author

Cameron K. Rokhsar, MD currently directs the NY Cosmetic, Skin & Laser Surgery Centre, and is assistant clinical professor of dermatology at Albert Einstein College of Medicine. Non surgical nose job is one of his specializations.

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