STATE OF THE ART COSMETIC SURGERY AND ARTISTRY

THE NEW YORK CITY PLASTIC SURGEON, PC

Surgical vs. Non-Surgical Rhinoplasty

In the last decade, and with the advent of so many amazing injectable products, there has been a move toward non-surgical cosmetic procedures. Marketed with low (or no) downtime, lower cost, and lower risk these procedures become very appealing. But sometimes the appeal of the non-surgical option masks the reality of its ultimate success. Often, the conversation about the actual pros and cons is lost, as is the one about who is or is not a good candidate for the procedure based on their goals.

How Is Non-Surgical Rhinoplasty Performed?

As a general rule, non-surgical interventions on the nose involve injectable filler. While there are many versions of filler, most share the fact that they represent naturally occurring substances that the body degrades over time. Some are larger particles, some smaller, and some last longer than others. A few are permanent, but these are used less often.

Who Is a Candidate for Non-Surgical Rhinoplasty?

Because fillers do just that- fill a space- they can only make things bigger. You cannot shrink a hump, rotate a tip, or make a tip less bulbous with a filler. You can raise the area around a hump to catch up to it, add a point on top of an existing tip to make it look pointier, or make a round shape higher on the end of the nose to create the illusion of a rotated tip. But none of these elements represent true structural changes in the nose itself. You can also not straighten or narrow a nose with filler alone.

What is remarkable about non-surgical rhinoplasty is that, even though you are not chiseling a shape, for the right patient, the result can mimic having done just that. For patients of Asian or African-American descent for example, for whom in many cases the nasal dorsum is low, fillers are a wonderful substitute for a nasal implant, and have far fewer potential complications. They can also be molded to the needed shape, and adjusted in further applications. For the typical reduction rhinoplasty that involves a dorsal hump and bulbous or droopy tip, the options are more limited.

Isn’t Non-Surgical Rhinoplasty Cheaper and Safer?

For some patients, a really good illusion is plenty, especially since they can avoid an operation by creating that instead. While it is true that non-surgical rhinoplasty avoids an operation, the apparent and actual benefits do not always line up.

For one, cost can be grossly underestimated. A surgical rhinoplasty can range from $5,000 to $15,000, with a non-surgical one starting at $3,000 and generally staying below $8,000. But when you consider that the surgery is a one-time cost, and the alternative requires constant upkeep, then it really is not cheaper at all. Add to that the need for at least bi-annual office visits, and this really becomes a full time job to maintain. If you use permanent filler, then the results can last, but the material can not be removed if things do not work out as planned.

In terms of safety, there is an assumption that surgery is always more risky than something non-surgical. While surgery does involve cutting and anesthesia, properly chosen patients who are safe for surgery and treated in an appropriate environment with credentialed professionals are assuming less risk than people commonly imagine. Bleeding and infection are possible, but they are also possible with filler injection. Furthermore, filler injection has the risk of small particles getting into the tiny vessels around the nose and ultimately causing problems with blood flow to the skin or the eye itself. The risk of this goes up with the number and location of these injections, and a full non-surgical rhinoplasty usually means a lot of injections in a treacherous area. One could easily argue that it is less invasive, but at times more risky.

How Do I Decide On Surgical vs. Non-Surgical Rhinoplasty?

For patients who are seeking an overall reduction in the size of their nose, a significant straightening, or a complete reshaping of the tip, surgery is more likely to work for you. Smaller changes and softening of lines, or augmentation rhinoplasties that need to fill in or build up shapes, are good candidates for non-surgical interventions. What is crucial in your evaluation of options is to have a clear idea of what you can expect from the ultimate result. There are many things that filler can do; but once these are done, if having a nose that has a nice shape but is globally bigger is not what you are looking for, you may want to go back to the basics.

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