How Is a Non-Surgical Rhinoplasty Done?

Hi, we're going to do a quick non-surgical rhinoplasty on this beautiful patient. I want to demonstrate why she's a good candidate for non-surgical rhinoplasty. If you look at her nose, she has two options. One is a surgical option to actually take this bump down. This bump is partially bone, partially cartilage. Both of these structures create a dorsal hump. The tip kind of comes down a little bit, so during surgery I would bring down the bridge, and this would be a preservation rhinoplasty most likely, because she doesn't need to be reduced that much. Then I would reshape her tip to put it in a spot like this. You can see by just getting the tip into a better spot, the bump is like 50 percent gone, 60 percent gone. So the tip coming up into the correct position balances out the profile with the bridge. And then I would just reduce this a little bit.

But she still is deep in an area called the radix, right here. Now, this gives us an opportunity, surgically, to elevate it slightly. You don't want it to be too high. But non-surgically, by elevating the radix and kind of pushing it up a little bit, what ends up happening is you create a better balance from the forehead down to the tip. When the radix is deep, in photography a shadow collects there, and it kind of looks like people are frowning even when they're not frowning. People can be like, are you mad, are you upset, is something wrong? The person's perfectly fine. They may even have Botox, but because of this shadow it looks deep. So elevating this actually creates a nice balance to the forehead.

Now, there's a limit there. You don't want to create an avatar. You don't want to create a Roman nose. You don't want to create Liam Neeson. She's not out there kicking butt and taking names, right? She still wants a cute, feminine nose. So I'm going to elevate this, but not too high. So not everybody's a candidate for non-surgical rhinoplasty, but she can get a nice result. I can also improve the tip a little bit by subtle elevation, but you're not going to get the same type of result as surgery. If she really wants to focus on the tip more, that's more surgical.

So hang on, watch what we're going to do. That's where the needle is. Now, I see a lot of people that take what's in a sterile syringe and transfer it to other syringes. Not a big fan of that, honestly. I mean, you have perfect control with this. You can change the needle as needed if it gets dull, but transferring this into other syringes can potentially increase the risk of infection. So keep it in the original syringe it came in.

A bit more right there. The needle is deep, getting right on top of the bone. The injections are precise, and you can see it right in front of your eyes how that curvature reduces. Injections are kept in the midline, but sometimes, if somebody has a deviated nose, you can inject the side that's more indented to create more symmetry. I come up here to the helicopter view and check where we are. I have my fingers to the sides here. I don't want the filler spreading. These are small micro-droplet injections. The bump is pretty much gone. I don't really see a bump anymore. It's a straight bridge.

Now, normally we talk about the tip. Again, the tip is super important, because if the tip is lower, there's more of a bump. If the tip comes higher, there's a curvature now. So look at how the tip is so important to the shape of the bridge. I'm going to go right down the middle. This always hurts more. I'm not injecting yet. I'm going to pull back on the tip, make sure there are no blood vessels. I'm going to do a little column. This column is almost like a columellar strut. It gives the tip more support. Now the next injection is more superficial, right down the middle. There's no blood vessel right here. The tip comes up a little bit, and now she's straighter.

I don't want to overdo it, so it's really important. I want you to pay attention to this. If you overdo it, if you put too much filler in the tip, you are going to make a big, bulbous tip. That's what's going to happen. You have to know the limitations of what this does. This is a liquid, it's a gel, it's not a strong cartilage. If you need significant tip changes, don't rely on this. Don't put threads in the nose. I absolutely hate threads in the nose. I've seen injectors do it. It's horrific, because it damages these beautiful lower lateral cartilages. It tears them up. Don't do it. It's a transient, temporary result, but the damage is permanent long term.

The filler is fine in the right nose. If you have the right nose for it. Most of the patients that come in for non-surgical are really not good candidates. Lots of Asians are great candidates. Some African Americans are good candidates. Occasionally you'll see Middle Eastern or Caucasian patients that are good candidates as well. But again, it's something different. You cannot get the same result non-surgically and surgically. They're different. And when you come in for a consult, I'm going to do computer imaging, and I'll show you both options, and we'll decide together.

So basically, that's the non-surgical. I'll do a little bit more on her, because I know some of this filler is going to go away. Now she has the perfect straight bridge. I'm going to check again here. Check out the symmetry. Tiny little drops, and we are done with the non-surgical.