Non Surgical Nose Job Rhinoplasty

Hi. We're going to do another injection demonstration in our video series of fillers and Botox injections today. It's one of my favorite subjects. We have other patients online that you can visualize non surgical rhinoplasty for. But today we have nose that can definitely benefit from both surgical and non surgical options. So I want to discuss that and go for both. This is often the case with most patients that are candidates for non surgical rhinoplasty. They're also candidates for surgical rhinoplasty, but not vice versa all the time. Ten years ago, nobody was doing non surgical rhinoplasties. It was unheard of. And most rhinoplasty specialists like myself were frowned upon. And we didn't want anything injected into the nose for the fear of scarring or infection. But over the last five to six to seven years, we've noticed that if you choose the right substance and by the right substance, typically it's Restylane, Juvederm or Belotera, one of the hyaluronic acids, you can get a really nice result and a significant portion of patients, but not all patients. So you have to choose properly. I've seen too many patients go to an average dermatologist, get something injected into their nose, end up with a larger nose, but not necessarily an attractive nose. So the same rhinoplasty aesthetics, the same goals of a beautiful nose have to apply whether you're doing a surgical or non surgical rhinoplasty. The reason I like the hyaluronic acid is that they're safer one, they can be removed and dissolved if you want to, but they're also clear soft gels. Some people come in asking for silicone artifil or more permanent fillers. That doesn't belong in the nose. Permanent fillers come with permanent problems. I've seen patients come in who've had permanent infections with permanent fillers in their face and you have to cut it up like cancer or put them on high dose antibiotics, put them into the hospital, give them intravenous antibiotics. If somebody has had an implant abroad. Implant can be easily removed. But a filler consists of thousands of particles and you can't easily remove it. So safeties first. If you're going to do something, definitely want to be safe. The other important aspects are what we talked about is the aesthetics of the nose. You can't just put a filler into the nose. You have to know what the radix height should be, what the tip projection, rotation. All these issues are important and you have to understand the aesthetics of the nose, take a look at the patient, examine the patient, then have a discussion. And I use computer imaging on almost most cases of non surgical rhinoplasty so they can see themselves what they can look like. Now, in this case, there's a beautiful young woman who has a small dorsal hump. The dorsal hump is luckily surrounded by an area that's depressed above it and depress slightly below it.

So in this situation, to get a straighter bridge, you can place a little.

Bit of filler above it into the area of the bony dorsum or the radix, and a little bit of filler.

To the area of the super tip.

Giving it a straighter profile. It's important not to try to go for perfect straightness sometimes because if you try to get it perfectly straight, it may be a little bit too high. So it's important to keep that in mind.

And the goal is to reduce the appearance of the dorsal hump.

Now, there are things that adding volume does when you raise the bridge. A lot of times it makes the nose look nicer and narrower.

Surgically, I could break the bones, do.

Osteotomies and make it narrow as well. Non surgically, I can't do that. But by adding a little bit of filler to the bridge, you can give it the illusion of narrowness.

Surgically, I can lift the tip up a little bit, I can narrow the.

Nostrils a little bit. Non surgically, can't do that significantly. But overall you can still get a nice nose. It's important for it to be balanced to the face. Age appropriate, sex appropriate, ethnicity appropriate, not to drastically change the nose. And I'm going to demonstrate that technique right now. So we have Restylane, again, the clear gel. The beauty of Restylane is its smoothness. It comes with a 29 gauge Teruma syringe. You want to make sure you have the bevel down. The tip should be down. We don't want to be inserting this under the skin. You want to be right on top of the bone or cartilage.

And I'm going to demonstrate that. So I'm going to start up here. I'm going to grab the skin. Elevated, gentle, be gentle. There's no reason to be rough with the skin. I've seen some people believe that if you penetrate the skin quickly, there's less pain. That's just not true. You can see it's little tiny droplets. These are not very large drops by any means. Then you mold and massage as you go. The nose is not as vascular as the eyelids and other areas. So bleeding and bruising is less common, but you still have to be aware of the surrounding. How are you doing? Okay.

Yes.

Not the worst thing in the world. Come along nicely. And already if you look, if you.

Kind of drop the camera angle down.

Just by injecting this area, you can see the bridge is smoother. I'm going to continue a little bit again.

Micro droplet.

How much of this have I used?

Barely anything.

It's just tiny, tiny, tiny little droplets. The other thing that's important is you have to be aware of brow tip aesthetic lines. You could draw a line from each eyebrow down towards the tip of the nose, each side. They have to be symmetric. Start narrow, progressively get wider.

So there are certain areas that you.

Don'T want to widen or create asymmetry. Now we're going to go down here a little bit more. Bit more sensitive here. One, because it's closer to the tip. Tip is more sensitive. Two, it's a new area that the lidocain hasn't really kicked in yet. So I switch sides and I'm always picking the skin up. You always want to pick up the skin as you inject and it's tiny. I mean, my thumb is doing the job. If you have to keep looking at the syringe to see how much you're injecting, you're not doing it right. You have to trust your thumb and know how much filler each pressure of the thumb is depositing. You can see it's beautifully starting to form. It's coming up nicely. You barely can see the bump anymore. I like to drop myself down to this level now. It's just a gorgeous profile there. I'm going to go a little bit more. I like to overfill just a bit because what you see today is not what you end up with five days from now. There is swelling. The restylane has other material in the syringe with it that goes away.

So I don't want her to look.

At this five days from now and wish that she had more. So from experience, from years of doing this, I can predict with some good certainty where we're going to end up by next week. And that'll be the result she's going to get. Now, any type of bleeding, just hold a little pressure and it'll stop. Again, the nose, I've not seen any.

Major bruises on the nose.

It can happen. You still want to tell people, don't do this before a major event in their life. Give themselves a week OR 2. But 99% of the time after a day goes by, it looks really good. Put on some makeup, get out there and enjoy everything without really manipulating this. I don't want people going home massaging it.

I don't want them going home putting any heavy ice packs on it.

They can put some cold, ice cold washcloths, but no heavy ice packs.

If their glasses sit in such a.

Way that it digs into it, I.

Don'T want them using it.

But if it sits on the sides and doesn't dig into the bridge, that's perfectly fine. They can wear glasses. I tell people not to exercise for just about a day or so. How you doing there? Still good?

Good.

It looks really good. And as the lid again is kicked in, it's probably a little bit more comfortable now than it was two or three minutes ago, correct? Yeah. Good.

You can drop the camera angle and.

See it again right here. How beautiful that profile is. There is no bump left anymore. You can see how straight that bridge is.

Now I'm going to consider putting a.

Little bit to the tip to just.

Give that a lift.

What do you think of that? You want to do a little bit to the tip. It's going to look good. Sure, if it looks good, it will. So the tip injection, it's very important to be conservative. Less is more. You don't want to put too much in the tip. Adding a little bit to the tip. Now I want you to show the camera angle again from the same side. And now you can see what happened to the tip. You got a little bit of a lift to the tip. Beautiful feminine dorsum. And the tip you just got a little tiny raise and projection which makes them look nicer. And from the base view, adding to the tip can even lift it up a little bit so you get a little cuteness to the tip as you.

Place and drop there.

But don't put too much.

You don't want to discolor the tip.

You don't want to damage the tip.

This was non surgical rhinoplasty using Restylane. And again, it's not a lot of material. It's not a lot of volume. It's small, tiny micro droplets placed in the right places. I see tons of African American patients, Asian patients, Caucasian patients. And today actually this is the third patient just this afternoon. And we do a lot of these injections. Do your research, watch the video, see the before and afters and then I'd.

Be happy to see you.

Sa.