In the not too ancient past, a rhinoplasty nose job was always a surgical procedure in which a bit of cartilage was removed or added or both, depending on the surgical goals. The plastic surgeon would make a cut inside the nostril or in the strip of tissue between the nostrils (columella), flip up the skin, and start reshaping the nose. Often the patient was groggy from anesthesia, bandaged across the face for days, and with two bruised (raccoon) eyes. Many patients endured this type of rhinoplasty nose job because the end result was more important than temporary discomfort and, quite frankly, there were few other options.
Nose reshaping has come to mean something different over the past five to ten years. While nose reshaping surgery still applies to the same old rhinoplasty nose job, the term nose reshaping now includes a number of non-surgical approaches such as injection rhinoplasty or botulinum toxin injection.
Injection rhinoplasty makes use of dermal fillers that are commonly used to treat fine lines and wrinkles. Dermal fillers used in injection rhinoplasty include Radiesse and Interpore 200 (both are calcium hydroxylapatite) and extrudable PTFE such as Gore-Tex, SoftForm, and Advanta. These “ceramic” or “plastic” soft implants can be injected under the skin to fill in unwanted depressions, straighten crooked noses, and decrease the appearance of a protruding dorsal hump (hooked nose). Botulinum toxin injection (BOTOX, Dysport) can be used by plastic surgeons that are experts in reshaping the nose to relax muscles of the face that are contributing to an unwanted appearance.
The main difference between a rhinoplasty nose job and injection rhinoplasty is that injection rhinoplasty requires more artistic finesse on the part of the physician. Injection rhinoplasty is about creating noticeable improvements with only subtle changes in nose shape and volume. As Alexander Rivkin, MD explains that while dermal fillers are actually adding small amounts of volume to the nose in critical locations, since the nose has a smoother contour after carefully applied treatment, the eye does not track to that depression or crooked part of the nose. When the eye is not drawn to the nose, the nose blends into the rest of the face, making the nose appear smaller.
The concept behind botulinum toxin injection is similar. Where wrinkles, lines, and taught muscles surround the face, the shadows and ridges can serve to frame or highlight the nose. Botulinum toxin injection flattens wrinkles and de-emphasizes a larger-than-desired nose, making it look smaller overall.
Of course injection rhinoplasty is the ideal nose reshaping procedure when the goal is augmentation. If patient’s desire a fuller nose or one that is enhanced in some way, adding to the nose with dermal fillers is an excellent approach. Augmentation rhinoplasty can be challenging when a person’s own cartilage is used since it is difficult to shape and to ensure an adequate blood supply. With dermal fillers, the augmentation is carried out with nonliving materials; therefore blood supply to the implant is more or less irrelevant.
The main drawbacks with injection rhinoplasty is that the injections are not permanent (lasting 6 to 12 months) and not every cosmetic problem can be solved by this technique. On the bright side, non-surgical nose reshaping is far less expensive and time consuming than a traditional rhinoplasty nose job. Injection rhinoplasty can usually be done for less than a thousand dollars and completed in less than an hour, with very little recovery time, if any.