Correcting cosmetic nasal defects with Radiesse results in a high level of patient satisfaction and gives surgeons an option for patients not ready for rhinoplasty.
Until recently the only option open to patients who wanted to improve the appearance of their nose was surgical rhinoplasty, a procedure that requires general anesthesia or intravenous sedation, up to two weeks of downtime, significant postoperative pain and substantial expense. The full results of the surgery might not be completely known for several months, and surgical risks including scarring, infection, and anesthesia complications. For patients with cosmetic nasal defects such as bumps, bulges, dents, and asymmetry, it isn’t surprising that making the decision to have rhinoplasty can be difficult. Now surgeons have an option that offers patients immediate, if temporary, relief from many of these bothersome nasal imperfections for less than $ 1,000. Seeing the results of this temporary solution can help some patients make up their mind to invest in the long-term surgical solution and offers others the ongoing option of correcting the defect on their own schedule when it fits their needs.
Patient Selection and Preparation
The nonsurgical nose job is one of my favorite procedures because it produces an extremely high degree of patient satisfaction. Patients find it hard to believe that with just 15 minutes of virtually painless, precise injections into the bridge, side wall or tip, we can recontour the nose to address many of their dislikes about its appearance. While nonsurgical correction cannot decrease the size of a large nose or change the shape of the nostrils, it is ideal for patients with bumps or dents, sideways deviations or a droopy tip in those who are not emotionally or physically ready for surgery. Fillers can even be used to refine problems that persist after rhinoplasty, although patients with multiple rhinoplasties may be at risk for skin necrosis due to changes in blood supply related to surgical manipulation.
Just prior to the procedure, we apply a topical mix of 6% lidocaine/6% tetracaine to minimize pain. I mark injection sites and the area is thoroughly cleansed with alcohol pads.
My preferred filler for nose jobs is Radiesse (BioForm Medical), an FDA-approved dermal filler consisting of microspheres of calcium hydroxylapatite (CaHa) suspended in a carboxy-methylcellulose gel. It is ideal for this procedure for several reasons:
* Correction with Radiesse lasts longer than correction with hyaluronic acid (HA) fillers – 6 to 10 months with CaHa compared to 3 to 6 months with HA.
* It provides more volume compared to HA fillers; small amounts of Radiesse can result in great differences.
* Calcium hydroxylapatite, a mineral found in bones and teeth, matches the consistency of the nose better than other dermal fillers.
* Radiesse is a paste-like substance, which molds easily and is less likely to migrate compared to HA fillers, especially in an area like the nose where the filler may be under pressure due to the limited capacity of the nasal skin to expand.
The procedure typically takes 15 minutes or less. Using a 27-gauge, half-inch needle, I inject the filler into the subcutaneous tissues or super-periosteal plane and then mold it into shape. The amount of filler used ranges from 0.1cc to 0.5cc, based on the type of deformity. Nasal bridge construction on Asian or African-American noses can require up to 1.0cc of Radiesse.
We apply ice immediately following the injections. Patients report little or no discomfort during the procedure.
Although there is no downtime and patients can return to work and general activities immediately, the nose can be slightly red and swollen, and the injection sites may be slightly sore for a day or two. There is a risk for skin necrosis as there is with any type of injection. I ask patients not to touch the area for a week, not to wear glasses (including sunglasses) and to forgo contact sports for a week. Patients are instructed to return for follow-up in two weeks.
We have encountered no lasting side effects with this procedure, and the level of patient satisfaction is extremely high. The nonsurgical nose job is a simple, minimally invasive technique for patients who are interested in improving the appearance of their nose without undergoing rhinoplasty.
Dr. Cameron Rokhsar is the inventor of the non-surgical nose job. He was the first to do this procedure in 2003 with Radiesse (called Radiance at the time). He has published the first scientific article on the subject in Dermatologic Surgery where he described the technique to other physicians. HE has lectured on this subjected numerous times at many scientific meeting including the American Society for Dermatologic Surgery. He has appeared on numerous shows including Good Morning America, The Rachel Ray Show, CBS News, FOC News, ABC news and NBC News regarding this procedure. His work on this subject has also been featured in USA Today and other publiations. For more information please visit www.cosmeticlaserskinsurgery.com
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