Your Questions
Your Questions
Q: Dr. Eppley, I am interested in a less complicated process to nose reshaping. I have researched non surgical rhinoplasty. Can I achieve the same results using Restalyne as with a surgical rhinoplasty? I’d like to raise my drooping tip, then straight/sharpen my bridge to give appearance of thinning?
A: Injectable fillers in the nose work exclusively by adding volume. Thus when evaluating whether an injectable or non surgical rhinoplasty will work, one needs to look at the nasal problem one is going to treat. Injecting the tip of the nose may be capable of lifting it but it will also make it wider or fatter in doing so. Fillers can raise a depressed bridge area and may be able to make it look a little thinner but I would not count on it making the nose straighter.
So to answer your question about whether a non surgical rhinoplasty can create the same result as a surgical one on your nose…probably not. Which raises the next question of whether it is good to do at all? I think as long as too much filler is not placed (a little goes a long way in the nose) then some improvements in the shape of the nose may be obtainable without any significant compromise. It is certainly the definitive way to answer the question of how effective a non surgical rhinoplasty may be and does not prevent one from eventually going on to a surgical rhinoplasty in the future.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a nonsurgical injectable rhinoplasty last year but I believe the effect might be over. My question is do you think I should consider rhinoplasty because of the projection of my tip when I laugh and my bump on nose. Or should i just get another nonsurgical rhinoplasty because the tip is bothering me. The problem is my nasal profile from side could be adjusted with injection of the but it doesn’t do anything to the tip and it droops or falls down when I laugh. Please let me know thanks
A: I believe you have really answered your own question about the decision for a second injectable rhinoplasty vs. open surgical rhinoplasty. One of the benefits of any type of non-surgical aesthetic treatment is to determine if its effects can produce an equivalent result as that of surgery. While an injectable rhinoplasty can provide augmentation to a low radix or bridge of the upper nose, it will have no effect on any other areas of the nose other than that of an illusory effect on the overall nose shape. It will certainly not have an effect on an overly dynamic nasal tip that pulls down with smiling or laughing. Thus, some form of surgical rhinoplasty is the only treatment that can treat both both the bridge and tip problems.
A surgical rhinoplasty for you would augment the bridge with either an implant or cartilage graft and resection of the depressor septi muscle if the only tip issue is its downward pulling.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in an injectable rhinoplasty. You probaby can’t tell by the pictures so much, but I have a droopy tip to my nose. The bridge is fine but from the frontal view it droops and I am wondering if it could be lifted up by injection fillers.
A: An injectable rhinoplasty can be very effective if used for the right nose problem. While injectable fillers can be placed into the tip of your nose, they will make it somewhat bigger in an effort to lift it which may be viewed as aesthetically counterproductive. It would be more predictable to do a simple tip rhinoplasty where the tip could be reliably lifted and avoid making the size and width of the tip any bigger. A droopy tip in a thick skinned male nose is not a good indication for the use of injectable fillers in nose reshaping.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a non-surgical rhinoplasty. I am a 32 year-old female who does not like her nose. My nose has a dent and a crack in it. It has always been there as long as I can remember but as I get older it seems to be getting worse. I am scared to get a surgical nose job because if I don’t like it I will be stuck with it. I know an injectable rhinoplasty is not permanent but it is less scary to me.
A: A non-surgical rhinoplasty, also called an injectable rhinoplasty, is a quick and fairly simple procedure that can be done in about 15 minutes. The only type of nose problem that is amenable to injection are those that can be ‘cured’ by the addition of volume. These include a deep radix, a nasal hump, indentations, depressions and some minor drooping tips. While almost any of the current injectable fillers can be used, it is safest to use a hyaluronic-based filler (e.g., Restylane, Juvederm) as it has good linear flow properties through a 30 gauge needle. There usually is little to no bruising and minimal swelling afterwards. The duration of the nasal correction will last as long as the type of injectable filler used, most commonly six to nine months.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve been wanting to get a rhinoplasty for awhile to augment my radix and glabella. My goals are to widen and raise the radix so that there’s a smoother transition between the nose and the brow ridge. Anyway, I have two questions:
1) Will I be able to achieve this through cartilage grafting, and if so, how long a recovery should I expect?
2) I’m hoping to get it done next year. As such, could fillers be injected into the radix and glabella in the interim? It would also serve the purpose of giving me an idea of the kind of augmentation that can be achieved. Also. if fillers can be used, how much filler will actually be required? Thanks!
A: The long-term solution to a deep radix is augmentation, albeit done with a synthetic implant or a cartilage graft. There are arguments to be made for either an implant or a graft but I will leave that subject alone for now. If that is the only thing that is being done to the nose, there is a very short recovery since such augmentation can be done through a closed rhinoplasty technique. If one is uncertain as to how one would look with radix augmentation, one could do either computer imaging or place injectable fillers as a ‘surgical test’. Usually most injectable radix augmentations take about .3 to .4cc of material to create the desired effect. While there are many different type of injectable fillers, one should use those that are composed of hyaluronic acid as these can be placed in the smoothest fashion and the timing of their resorbability can be adjusted based on the specific product used.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a non-surgical rhinoplasty. I really need my nose fixed. I’ve been so depressed about my nose for about 7 years. I’m 20 years old now. I know I can’t afford surgery so I thought hopefully I can afford this. Why stay sorry for myself when I can do something about it, please help ! I have attached a picture so you can see my nose shape problem.
A: Based on your picture, you are not a candidate for a non-surgical rhinoplasty. This very limited nose reshaping technique uses injectable fillers to build up certain parts of the nose. Almost always that is done to build up the area above a hump or bump in the upper nose. What you have is a wide or fat nasal tip due to large lower alar cartilages and how they come together…or don’t come together. Correction of the wide nasal tip requires an open surgical approach with cartilage reduction and reshaping with sutures. That can be tremendously effective in reshaping the tip of the nose but it is a surgical procedure. Just for a tip rhinoplasty procedure done in a one hour procedure under general anesthesia the cost is around the $4,000.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to know if I can have a non-surgical rhinoplasty for temporary basis. At the moment I do not have sufficient funds to afford a rhinoplasty. Will there be dying of the skin or problems with the skin if I do this. Do you think i can have this procedure based on my nasal anatomy. Please let me know thanks.
A: The best type of nose for a non-surgical or injectable rhinoplasty is the patient with a small to moderate-sized dorsal hump. This provides a perfect place to place an injectable material above the hump in the upper nasal bridge or nasion area. By so doing the hump is camouflaged as the dorsal line is straightened from the tip of the nose up to just below the eyebrows. Your nose is the perfect candidate for it as you fulfill this anatomic criteriua. I have attached some imaging which shows what the result would look like. The only question is what type of injectable filler to use of which they are a large number of choices. I would chose one of the longer acting ones like Radiesse or Juvederm XC which should last about a year. This is done in the office under topical anesthesia and takes about 10 mnutes to perform…which is why the procedure has earned the name of injectable rhinoplasty or ‘lunchtime’ rhinoplasty.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m 14 going on 15 and I hate the shape of my nose. What i want is some kind of injectable filler to go in the top of my nose (the part in between my eyes) because that is where you can really see the hump and I want to lift that bit of skin/fat to even out my nose. Would I be able to do that at the age of 14?
A: The first thing to point out is that at age 14 I can not have any type of communication with you without written consent from your parents. I am not even able to answer your questions until I receive such consent. Providing medical information to potential patients on the internet is somewhat similar to seeing you in the office. I wouldn’t be able to that without at least one parent in attendance. (sent to patient)
Injectable fillers can be used to build up the upper bridge of the nose (radix) to help camouflage a hump or bump on the nose. This is probably one of its best uses when it comes to non-surgical or injectable nose reshaping. Whether this is a good idea at age 14 is a matter of debate and that is best determined by a discussion between the teenager and the parents. It can certainly be a good test to determine if a more formal rhinoplasty will one day be a satisfactory procedure to undergo.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I found your article fascinating on injectable rhinoplasty. I had a rib cartilage graft done 16 months ago but still have a depression to the left side of my mid bridge. I have banked rib cartilage left in my chest. Could the same technique be used with rib cartilage?
A: Any source of cartilage can be used in the injectable rhinoplasty technique. That is the very beauty of its use. Whether it be septum, ear, or rib, cartilage of any size or amount can be diced and injected. When an injectable rhinoplasty procedure is used, it is because only a small amount of cartilage is needed for the correction of a precise nasal defect.
Your banked rib cartilage would be a perfect donor source because it is likely more than adequate in the amount needed. It can be diced into a syringeable graft regardless of its present configuration.
Dr. Barry Eppley
Indianapolis Indiana
Q: Does Dr. Eppley perform non-surgical rhinoplasty? If so, how many has he done and what does it cost?
A: I have performed non-surgical rhinoplasty, otherwise known as using an injectable rhinoplasty. It is about using an injectable filler most commonly in the upper part of the nose (radix) to treat (hide) a hump. I have done that office procedure numerous times. It is only good to fill the bridge area above a hump to make it smooth. In a few other cases, I have used injectable fillers for small areas of fill-in for dents and asymmetries in other parts of the nose. But you can’t do a complete rhinoplasty or even a partial rhinoplasty in a non-surgical fashion. So the concept of an injectable rhinoplasty is for filling in small defects in the nose. It is also important to realize that these effect are temporary (one year or less) and not permanent.
I would have to see pictures of your nose to determine if this procedure is for you. If so, the usual injectable filler used is Radiesse because it lasts the longest although other fillers can be used. (e.g., Juvederm)The cost of the procedure is based on how much filler is used and what type. It could range anywhere from $350 to $850 depending on those factors.
Another form of injectable rhinoplasty is that using diced cartilage. While it does require a septal graft harvest, the cartilage is diced and injected through small syringes from an incision inside the nose. This injectable rhinoplasty procedure does require an anesthetic to perform and so it is better called a minimally-invasive rhinoplasty.
Dr. Barry Eppley
Indianapolis Indiana