Each week, Dr. Lara Devgan answers questions submitted by readers like you. If you want to ask Dr. Devgan a question about plastic surgery, aesthetic treatments, or skin care, you can do so hereTo kick off the series, we posed a common question from the RealSelf community: Who makes the best candidate for a nonsurgical nose job?

Here, Dr. Devgan shares how she determines which patients make the best candidates, how the treatment is performed, and why she steers clear of silicone fillers.  

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Nonsurgical rhinoplasty is one of my favorite cosmetic procedures. It has a RealSelf Worth-It rating of 91%, and for very good reason. The procedure is applicable to almost any kind of person — from any age group, background, and skin type.

The most common reasons I do nonsurgical rhinoplasty are to help people with a dorsal hump or bump on their nose, a droopy or bulbous nasal tip, or imperfections from a prior surgical rhinoplasty.

 

First things first

When you come into the office for a nonsurgical rhinoplasty consultation, I first try to understand what your goals and expectations are. Also, I need to know if you’ve had any other surgeries to your nose (like a surgical rhinoplasty), if you’re ever had trauma to your nose (like a nasal fracture), and if you have issues like a deviated septum or chronic snoring. So we do a full nasal history.

Then I examine your nose, with you holding a mirror so you can follow along with me. Then we talk about the different aspects of the nose and look at it in proportion to the whole face.

Everyone has different goals and desires for their nose. In most situations, an aesthetically attractive nose will slip into the background of the face, allowing you to appreciate a person’s eyes, lips, and cheekbones a little bit more.

 

What are the pros and cons of a nonsurgical nose job?

Once the consultation and exam are done, I talk the patient through what I’m able to achieve for them nonsurgically versus surgically. With nonsurgical rhinoplasty, all I can do is add filler.

Surgery is the gold standard, because it’s inherently more powerful. It’s permanent, and it allows me to add and subtract, to reshape and recontour tissues. If someone has a deviated septum or a very wide nose, widely splayed nostrils, a very bulbous nasal tip, or a nose that’s just over projected (overly large for their face), those situations are really hard to fix with a nonsurgical rhinoplasty.  

Surgery also ends up being a more cost effective in the long run, if you want to keep up your results.

The benefits of nonsurgical rhinoplasty are that there’s no downtime, and it’s very quick — it takes 5 minutes. It’s relatively comfortable for patients, and they can go back to their daily life right away. It’s also significantly less expensive.

 

How long do results last?

The main drawback of a nonsurgical rhinoplasty is that it’s not permanent, and how long it lasts depends on a patient’s anatomic characteristics and basal metabolic rate. In the same way that on the same diet some people will be skinny and some will be obese, some people metabolize filler in a few months, while others have it last a few years. That factor is not controllable. However, there are factors like lot of of scar tissue or heavy scar tissue, that tell me the filler will likely dissipate faster.

The type of filler used can also affect longevity. Most of the fillers doctors would use for this, like Voluma or Restylane Lyft, can last 1 to 2 years, in an ideal situation. But there are patients where those fillers don’t last that long. I try not to disappoint people by giving a long range, so I’d say the average is 8 to 16 months. I’ve seen patients after 3 years who still have good results, and I’ve also seen patients after 3 months who need to do it again.

 

How does nonsurgical rhinoplasty work?

I always get this question, because on paper, it makes no sense. You’re adding something, but the nose looks smaller. It’s basically an optical illusion. By understanding the anatomy and the artistic proportions of the nose, you can create the appearance of a smaller nose, even though you are adding material. If you measured it, volumetrically it would be bigger. It’s the same way you can draw a bunch of lines on a paper and make it look like cube. It’s about understanding proportions and how the mind sees things.

 

What’s the best filler for a nonsurgical nose job?

There are many types of filler that can be used. In my opinion, it’s safest to use a hyaluronic acid (HA) filler, one that’s fully dissolvable. In the event of accidentally injecting it into an artery, you need to be able to dissolve the filler. As long as you are using an HA filler, you should be safe. However, not all HA fillers are created equally. In my opinion, you want to use a filler that has a high G prime (a measurement of a filler’s ability to lift tissue). Something with a high G prime has good liftability. I’ve used a bunch of different kinds of fillers, and at this time I primarily use Restylane Lyft.

Some doctors perform a permanent nonsurgical rhinoplasty by injecting silicone. That’s not something I think is advisable, for a number of reasons.

Number one, if you accidentally inject a blood vessel around the nose, you are just stuck: there is nothing you can do to reverse it. You can watch the nose die right in front of you. You can watch blindness occur right in front of your eyes. And there’s nothing you can do about it. So to me, even though that’s an extremely rare event, it’s really not worth the risk.

Number two, injecting free silicone is permanent, and you’re not sure how your body will respond. The tendency will be to wall the silicone off and try to push it out of the body. You can get distortion, enlargement and disfiguration over time. So I don’t think silicone is a good idea.

 

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