Your Guide to Permanent Non-surgical Nose Jobs

Explore transformative non-surgical solutions for nasal irregularities with Dr. Eric Joseph. In this video, Dr. Joseph showcases various cases where Silikon-1000 injections are used to address issues such as saddle nose deformities, nostril retraction, and dorsal humps, providing natural and permanent results without the need for traditional rhinoplasty surgery. Discover how these innovative treatments can enhance nasal aesthetics while maintaining functionality.

The Evolution of Permanent Non-surgical Nose Jobs

What is it? Who's a good candidate? Permanent non-surgical nose jobs in our practice utilize a permanent filler called Silikon-1000. Silikon-1000 is purified polydimethylsiloxane or medical-grade silicone oil that has been FDA approved since 1996 for injection into the eyeball for retinal purposes. We use it off-label to fill imperfections, indentations, and similar issues in the nose. I prefer to use a sterilized glass syringe due to the high-pressure nature of the injection, along with a small needle, which allows for precise and accurate product placement.

The concept of a permanent, non-surgical nose job was first described by Dr. Richard Webster in the 1980s. Dr. Webster, a renowned rhinoplasty specialist, documented a series of around 2,000 patients from 1964 to 1984. Over that 20-year period, he demonstrated the precision, safety, and permanence of medical-grade silicone oil for non-surgical revision rhinoplastic procedures, enhancing the results of patients who had already achieved good outcomes with conventional surgery. The use of liquid injectable silicone for this purpose dates back 60 years to its origins in New York City, passed down through generations of rhinoplasty experts.

It's important to differentiate this approach from temporary gel fillers, which are more popular today. We do not recommend temporary gel fillers in the nose for several reasons. They can occasionally lead to necrosis or tissue death, particularly in patients who have undergone prior nasal surgeries and may have compromised blood flow. Additionally, there have been rare cases of temporary gel fillers causing blindness, stroke, infections, and biofilm formation. Hyaluronic acid, commonly used in temporary gel fillers, poses similar risks due to its thick gel consistency, which can block blood vessels if inadvertently injected into them, potentially causing serious complications, especially in patients with a history of rhinoplasty.

In contrast, we have utilized Silikon-1000 for 25 years with experiences echoing those of my mentors in the field. It has proven extremely safe, offering excellent precision, permanence, and long-term stability, particularly beneficial for patients with prior rhinoplasty surgeries. Unlike temporary gel fillers, Silikon-1000 treatments typically require one to three sessions for optimal results and cannot be removed once injected, underscoring the importance of careful injection techniques.

In summary, there is a six-decade history of safety behind Silikon-1000, and our own 25-year experience with thousands of patients has been overwhelmingly positive, especially for those with previous rhinoplasty procedures.

Before & After: Correct a Left Tip Indentation

Our first example is a good illustration of someone who has undergone three rhinoplasty surgeries. You can see a significant indentation on the left side of her nasal tip. In the after photo, the indentation is no longer visible. This improvement was achieved through two treatments with microdroplets of Silikon-1000 at monthly intervals. You can observe that the previous surgical mark, the indentation, has completely disappeared and will not return.

Before & After: Created Nostril Asymmetry & Added Volume

The second example also involves a patient who has undergone previous rhinoplasty surgery. She has thin nasal skin and a persistently wide and crooked nasal appearance, along with an indentation along the left nasal sidewall. Additionally, there is significant nostril retraction and asymmetry. In the after photo, her nasal appearance is much more natural and straight, with nostril margins now at the same height.

Unlike temporary gel fillers, Silikon-1000 works very well in the nostril margins for lowering them, achieving nostril symmetry, and adding volume where needed. In this particular patient, the indentation along her left nasal sidewall was filled with topical anesthetic. There is no downtime, and the results are permanent. This provides a favorable alternative to revision rhinoplasty surgery for many individuals.

Before & After: Camouflage a Profile Bump & Create a Straighter Nasal Appearance

Our next example is someone who experienced an over-resected bridge after previous rhinoplasty surgery, where the bridge was lowered excessively. In the before photo, there's a noticeable depression in the mid-bridge. After three treatments, you can see a permanently raised nasal bridge appearance on the right. The small bump has disappeared, resulting in a more natural and pleasing nasal appearance without the need for further surgery.

Before & After: Raised Bridge Appearance

Similarly, the next case is also an example of over-resection. I wouldn't call it a saddle nose deformity, but rather a disproportioned nose tip and bridge tip. Her nasal bridge is too low, which gives the appearance that her tip sticks out a bit too far. After several treatments, you can see a pleasing raised bridge appearance without any signs of previous surgery.

Before & After: Lowered Nostrils, & Added Volume to Her Nasal Side Wall

The next example also involves nostril retraction and a small indentation on the left side wall of the nose, in a different patient. Nostril retraction means that when viewed straight on, there's an increased visibility of the nasal airway, often forming an inverted V appearance at the nostril margin. This tends to occur at the anatomical location of the soft tissue triangle, which can be elevated after rhinoplasty surgery.

In the after photo, you can see a much more natural-looking nose with symmetry in her nostril margins and straight bridge lines, without any indentation.

Before & After: Correcting Tip Asymmetry and Pinched Appearance

The next example is also a patient who underwent previous nasal surgery, with a slightly crooked and pinched tip appearance. Additionally, there is nostril retraction in the after photo, showing fewer, if any, signs of surgery. The goal here is to achieve a natural blend for the nose, avoiding any obvious signs of a nose job.

I often compare a permanent, non-surgical nose job treatment to how someone might have looked about three or four months after surgery, when their tip was still slightly swollen. Over the course of a year to a year and a half, as all swelling resolves, these irregularities tend to become apparent. This phenomenon is known as the shrink wrap effect and is typically associated with thin, white skin and relatively firm underlying cartilage.

For treating the shrink wrap phenomenon, I am not aware of anything better than microdroplet treatments with Silikon-1000 in the appropriate patient.

Before & After: Corrected The Indentation of Her Left Bridge

The following example is another patient with nostril retraction, more pronounced on her left side than her right, and a sidewall indentation. We lowered both of her nostril margins to reduce nostril show on both sides. Additionally, we filled in the indentation along her left nasal sidewall to lessen the operated nasal appearance.

Before & After: Filled the Large Concavity on Her Bridge

This is another example of previous rhinoplasty surgery performed elsewhere, where the patient was very dissatisfied with nostril retraction. It's unnatural to have upside-down triangles at the nostril margins, but this can be easily repaired with a few droplets of Silikon-1000 directly into the retracted area. This helps to lower it for a more pleasing nasal appearance and, in this case, achieve a straighter nasal profile without any signs of previous surgery.

Before & After: Nasal Tip Irregularity Correction

This example is another lovely illustration of camouflaging the signs of previous rhinoplasty surgery. This patient has what's known as a nasal bossa. You can see visible cartilage in her nasal tip protruding through thin, delicate skin. This wasn't apparent to the patient for many months after surgery.

In the after photo, by adding permanent volume to the tip of her nose, we've successfully masked this irregular cartilage from poking through her thin nasal tip skin. Additionally, we lowered her nostril margins to reduce nostril show.

Before & After: Nasal Bump Camouflaging

The next example is a patient who has never undergone rhinoplasty surgery and has a small dorsal hump. Silikon-1000 is not as robust a filler as hyaluronic acid (HA). HA is a hydrophilic filler that loves water and retains it, allowing it to achieve results that Silikon-1000 cannot.

For a treatment to camouflage a small dorsal hump, typically two to three treatments are necessary at monthly intervals, especially when addressing issues in the nasal tip and the lower third of the nose. Sometimes, one or two treatments suffice to achieve the desired result. This young lady disliked the small dorsal hump on her nose, which was permanently camouflaged without the need for rhinoplasty surgery.

Before & After: Correct “Saddle Nose” Deformity & A Pinched Tip

This particular patient exhibits many signs of previous surgery that I wanted to include. He has a saddle nose deformity, where the bridge of his nose was overly resected, resembling the saddle of a bison. Additionally, there are bulges in his nasal tip where cartilage knuckles protrude through thin nasal skin. He also experiences significant nostril retraction.

After three treatments, you can see in all views that he now has a less operated nasal appearance that looks completely natural, much to the patient's delight. Undergoing revision rhinoplasty surgery with cartilage grafting to the dorsum and tip would have been a major ordeal. Silikon-1000 injections provide an excellent alternative for patients with nasal irregularities, especially in noses that are not excessively large and do not have breathing issues. Injecting fillers into the nose does not impact breathing, positively or negatively.

Before & After: Three Treatments Performed Over Three Years

The last example that I'd like to show is also a patient who has not undergone rhinoplasty surgery. She is an Asian patient with a broad, flat nasal appearance, and she was generally satisfied with how her nose looked from the front. Her main desire was to achieve a higher nasal bridge. This example demonstrates permanent bridge raising after three treatments without the need for rhinoplasty surgery.

Conclusion

So I hope that you found this interesting. We offer free digital consultations where you can upload your photos with a description of what's bothering you. And I'd be happy to look at your photos to answer the question whether or not you may or may not be a candidate for a permanent, non surgical nose job treatment.