Am I a Candidate for Liquid Non-Surgical Rhinoplasty?

Whenever you're ready.

I'm ready. Go. Hi, guys. So we have a beautiful patient in front of us who is ambivalent about which way she wants to go, whether she wants to do a permanent surgical rhinoplasty or whether she wants to do like a temporary liquid, one of these, like five minute rhinoplasties. Luckily, she has both options. Not everybody has both options. A lot of patients are not good candidates for non surgical rhinoplasty. If you have a really large nose, protrudes a lot from your face, really droopy, you're just not a candidate for non surgical, especially if you have really thick skin. But if you have a flat nose, most Asian noses are great, some African American, some Latino noses are great. But in this situation, we have a Middle Eastern nose that has a classic dorsal hump, but there's space below it and above it to basically be able to smooth it. And I'm going to show you now the one thing, the most important thing is realizing in these situations, the non surgical result is very different than surgical. And I've told her and she knows it. I'm going to tell her, you can't have a slice of pizza and say, I love it now let me have an apple. They're two different animals, two different things. So if she loves the non surgical surgery is not going to give her a more permanent variation of that. It's going to be very different. We've done computer imaging, I've showed her. If she wants to post it, she can, obviously, but they're very different looks. So over here what we're going to do is she does have this little small dorsal bone going to fill above it, I'm going to fill below it and I'm going to put a little bit to the tip. Now, surgically, I would do the opposite. I would actually bring the bump down, reshape the tip and this part that's hanging down, reshape it and reshape these cartilages into a much better shape and also be able to create more symmetry from the front. So there's some limitations non surgically, but we can still do a really nice job. So hang tight, you'll be able to see it. I'm going to use hyaluronic acid product. You already prepped it, but we'll do it one more time. So this is a hyaluronic acid. It is reversible. You can melt it and dissolve it if you need to. I don't like permanent fillers in the nose. Avoid permanent fillers. So let's switch. Actually, we're going to be on the other side. You can see how this is done. So I tent up the skin and I go right into the radix and I put a little drop right there. I'm keeping it deep, keeping the midline and I smooth it out. I'm going to keep the process going. Another one, smoothing it out. And if you drop down, you can see like the bump is 80% gone already. Right? It is that quick. Now I have seen people thread a long needle this way. Don't do that. I've seen people put threads, actual threads. Thread lifts barbed wires into their nose. Please don't do that. These cartilages are very gentle, very flimsy, very fine in nature. If you put a big needle through here, you can really damage these. We don't want to do that. So the bump is so much reduced right now. Now, as you know, with every filler, whether it's lip injections, whether it's whatever it is, any filler is going to settle down over the next few days. So what you see today is a little bit higher than what you're going to see later in the week. So I'm going to always add a little bit of more overcorrection and by overcorrecting it, she'll have a nice result. Now this lasts up to a year, but we always have our patients come back in six months to do a little touch up. That way they're maintaining results year round. I'm going to show you one thing else, one of the most important thing is sometimes you may not be able to or want to completely cover the bump because that would require in some patients to come up too high. You don't want to have a perfectly smooth, bumpless nose if it's coming off your forehead. You don't want to be an avatar. You don't want to be super masculine. We don't want to create that. These are little tiny micro droplets. One of the most important things in injecting the nose or anywhere on the face is you want to keep the injections low pressure. You don't want to put too much pressure while injecting because what can happen is vascular occlusion. We don't want that to ever, ever, ever happen. So it's low pressure again. I have seen some of these videos online where the injectors are really laying in on the plunger, putting vast amounts of volume as well as pressure there. We're gonna go and walk our way down towards the mid vault now. It's a little bit more sensitive. See how she jumped? She felt it. She's going to tell us how she feels about that. But we're going to also create more symmetry on the front view. The side that's more concave when you inject it, that makes the nose look straighter. So you can make a nose that's asymmetric and crooked look straighter with fillers. And sometimes that means after surgery, somebody may have had a previous rhinoplasty and need a revision. But if there's opportunities for using filler, you may not need to do another surgery. You okay?

Yeah.

Hang in there.

Does it look pretty out?

Yeah, it's getting there. Now, one of the things up here when you get up to this radix, is if you want to really inject it to lift it up high, too high or high enough, it will start to spread on the front view. So again, that's another limitation to how high you can go with the filler. Because if you keep going higher, higher, the material is liquid, It'll spill over. You guys have heard of filler migration, which I have always set is a complete nonsense. Fillers do not migrate. But fillers do spill over. If you put too much volume in one area, it'll just spill over and it'll give that look of migration. Fillers will never move. Looks really good. We're almost done. Hang in there. The upper part of the nose is less sensitive. The lower part is more sensitive. For female patients, I'm going to tell you a little pearl. Any injection, Botox, fillers, lips, nose, whatever, it hurts 10 times more if you're on your period or even close to it. Even if you're just a few days from it or to it, it's going to hurt a lot more. Now we're going to do a little bit to the tip. Now, she has a phenomenon called a hanging infratib lobule. So the lower lateral cartilage comes down. It's too long here, and it's bowing and it's hanging down here. We don't want to press it up surgically. That doesn't look good. But surgically you can reshape it to get rid of that hanging.

So when you say phenomenon, you mean.

Like very uni, very unique? Well, I always wish you were rare, but actually, this is we see quite often, so it's not unheard of at all. But if you look at the profile, looking good. She still has a little bit of a saddle there. I'm tenting the skin up. The technique the first time we do it, the reason we have patients come back for a little touch up at six months is that the first time we do this on a virgin nose, it's a lot of poking. I mean, it's micro droplets. There's hardly any bleeding or bruising, but still a lot of poking. You got to create this nice layer of filler in there, but it's easier to maintain it. So when she comes back in six months, it is easier to do it. Less poking, less time, less cost. We use a smaller syringe or filler to basically just keep her filled up. The analogy is like your gas tank in the car for those who don't drive EVs yet. You don't want to run out of gas. You want to go back to the gas station when it's half full. So bump is gone. Still a little super tip break. I don't want to get rid of it completely. I think it's nice and feminine. Every nose has to be customized. This nose fits her. I think if you have a totally straight nose on her face would be a little bit too masculine.

So when you fill the bottom part, does it lift it up?

It doesn't lift it. It gives it the illusion of a different shape tip. You'll see in a second. So there's no way of taking this and lifting it. Right. You see it on Instagram sometimes. And I would suggest there is a little bit of photoshopping going on on those.

Do some people use Botox so too, but effect.

Great question. I had a lot of patients come in here and say, can we do Botox? Botox will never lift the tip or prevent it from dropping. The only time it does that is if when you smile. Smile for me. See, you have a normal smile. But some people, as they smile, the lip completely tucks under. They show all their gum and the tip kind of drops down. So what you're doing is not really affecting the nose. You're affecting the upper lip. If I can reduce your smile by like 30%, your nose will drop 30% less. But the right way of correcting a droopy tip is surgery. Much more symmetry from the front. If you come up here, actually take a shot of this. This is called a helicopter view. Helicopter view is from top. You tilt your chin up a little bit. The lighting is a little bit with this. If you look. Yeah, the shadows and stuff right there. You can see how straight now it is right there. These are called brow tip aesthetic lines from each eyebrow down the side towards the tip. All Right, let's go do the tip. Now. Switch needles.

Nose man's off to work.

Looking good. So we're gonna do a little tip tip. And now here, I'm actually injecting the distance between the columella and the tip itself. This is the infra tip lobule, and we're going to give a little bit more projection. It is a very superficial injection. It's right on the skin. I'm not worried at all about any vascular occlusion right here. I'm not going in deep. This is just a very, very small superficial right underneath the skin, creating better tip lines. Now, if she was truly lacking structure here and she didn't have tip support, I would take the needle all the way down to the upper lip and fill it up. In that situation, you 100% need to do a checking, pulling back on the plunger to make sure you're not in the blood vessel. But in this situation where it's right underneath the skin and I know the anatomy here in the midline, there's nothing there. You don't have to worry about that. All right. Looks really, really, really good. I've got a little bit more room right here. Perfect. Now, if you look at it, literally perfect. Straight nose. All right, while you're videoing, bring up the camera. I mean, not the camera, I'm sorry. Your mirror in your hand. Moment of truth. Okay. Clean you up. Give you a little pep talk. All right, Go. Oh, wow.

Oh, wow. It's so beautiful. How'd you do that?

You'll get to see the video. Looks really good.

What?

Looks totally straight.

Oh, this is so cute.

I mean, the bump is, like, 95% gone, right? I didn't want to overdo it. Yeah, and make it too high. I don't want you to be like Liam Neeson, like a really high bridge.

This is a cute look.

And the tip blends in better with the thing. And take a look. Go on the big mirror, you can see yourself much better. So much straighter it is. And the tip also doesn't, like, stand out.

This is a vibe. I like it.

You like it. Cool. All right, cousin, thanks.