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Q & A for Non-Invasive Rhinoplasty

1)      What is the aesthetic procedure Non-invasive Rhinoplasty all about?
Every person is interested in looking good and having a beautiful nose and they are willing to undertake the procedure without giving much thought if it is non-surgical. The only way a nose could have been improved till recently was through surgery which had its risks, down time and the fact that it was irreversible. More so people viewed it as something that can be dramatically transformed. Surgery of the nose required a lot of Finesse and training and only a well experienced and trained Cosmetic Surgeon could provide an expected outcome.

Non surgical or non-invasive rhinoplasty is being sought after by many patients. This procedure which involves use of Hyaluronic acid injections to augment areas of the nose can only be used when the nose looks flat and is ill defined. It is more of a camouflage procedure where the discrepancies and depressions are improved by injecting fillers to get a defined nose.
2) What are the targeted problems for which both can be used?
Non surgical rhinoplasty is ideally suited for people who have a flat and a wide nose. A bulbous tip can also be defined by the non surgical procedure.

Depressions, deviations and unevenness can be smoothened out with these non surgical procedures. It is also very helpful in people who need minor touchups after a nose surgery or do not have time for recovery from surgery.
3) What is the science behind Non-invasive Rhinoplasty and how is it different from Invasive Rhinoplasty?
The principle behind Non invasive rhinoplasty is to augment areas of the nose by the use of Fillers. These are injections made of Hyaluronic acid having different molecular weights which decide their viscocity as well the duration for which these will last. The areas requiring augmentation is marked and then a numbing cream is applied in the area. These pre filled syringes ( usually containing 1 ml of the filler) are taken and the filler is injected through a tiny needle or a cannula onto the dorsum of the nose to raise the height and define the dorsum, into the tip of the nose to raise it and make it look sharper, into one or the other side of the nose to correct the deviation. It is sometimes also used to support the nose at its base so as to correct asymmetry. These last for about 12-18 months and have to be repeated once the body starts absorbing these fillers. The molecules of these fillers are normally  present in all cells of our body as building blocks which is the reason that they are being broken down by the enzymes of our body.
4) How often do you recommend your clients for the treatment?
Surgical rhinoplasty is always the first and the safest choice to reshape the nose as once done, the result obtained is permanent and the shape looks natural. Non surgical rhinoplasty cannot reduce the size of the nose, cannot straighten a crooked nose, cannot improve breathing problems nor can it be done to address cleft lip nose deformity.

We recommend this procedure only if the patient wants to augment the nose and not having enough time for recovery or is strictly against nose surgery. About 2-5 patients are offered this procedure every month and after discussing the procedure in detail and after knowing the need to repeat this every year most o fthem decide to undergo the surgical rhinoplasty.

5) Can Non-invasive Rhinoplasty be combined with any other treatment? If yes, then what are the benefits?
Non surgical rhinoplasty can be easily combined with non surgical facial procedures to improve the overall look of the face. Chin and cheeks can be augmented and the jawline improved. Undereyes can be filled so that the dark circles do not look prominent. Lips can be augmented too at the same time.

The benefit of undertaking these procedures at the same time is the limited downtime if any that the patient has to go through for the area to look normal. This procedure is not combined with any surgical procedure as it has to be done in the sitting position.

6) Are there any side-effects of these treatments? 
The chances of risks in a Non surgical rhinoplasty are small but very prominent. The usual concerns include bruising and swelling of the area where the injection has been made. These subside on their own over a period.

The less common risks include over or under injection in the area. Over injection can give a lumpy look or a bump which can be reduced by dissolution of the filler using Dr. Thomas’s technique and formula. Touch up procedures may be required if the area has been underfilled.

The greatest risk of non surgical rhinoplasty is loss of vision which is extremely rare. This happens due to the filler tracking into the blood stream and blocking the artery supplying the retina. This happens because the blood vessels of the nose are in very close relation with those around the eyes. This cannot be reversed and the person can lose sight on the affected side for life. Diffusion into the blood supply can also cause reduced supply to the nose tip and/ or the cheek skin which can cause loss of skin and tissue leaving very prominent scars.

Dr. Thomas prevents these complications by undertaking non surgical rhinoplasty under 3 dimentional vision control. High definition ultrasound is done to assess the presence of blood vessels and then the filler is injected in areas away from the blood vessels. Use of this highly modern safety step has  prevented any such major complications in our practise.

7) What is the time taken for the procedure?
The usual time taken is about 45-60 minutes depending on the extent of improvement required. Once the area is marked, numbing cream has to be applied and left for about 30 minutes. This is then followed by filler injections to get the non surgical rhinoplasty result.
8) What are the pre and post-treatment measures to be followed?

The pre treatment measures include-
To stop smoking if the patient is a smoker. If the patient is on blood thinners then they have to be stopped 5 days prior to injection under the guidance of the doctor who prescribed them. Any procedure if done on the nos should have completely healed before coming in for the procedure. If the patient has medical issues like Diabetes, High blood pressure etc then these should be under control before coming in for the procedure.
Post treatment, the patient should use cold compress for 10-12 hours over the injected area to reduce bruising. Antibiotics and anti inflammatory drugs may be prescribed to reduce inflammation and prevent infection. Facials and massage should not be done in the treated area for about 2 weeks.

9) How do your educate your client about the procedures?
Education about this procedure includes a preliminary discussion about the patients concerns and possible options to improve the area. This discussion goes on for more than an hour and may include showing photographs of patients who have undergone similar procedures in the past. We also provide people with brochures about the procedure with photographs of outcomes. We also discuss all possible options including surgery to improve the particular area.

10) How many sessions are recommended for a visible difference?
Usually one session is more than sufficient to make a meaningful difference in the area. Sometimes more than one touch-up sessions may be required to make the area look better.

11) How prevalent is this procedure in India?
Indians have a special affinity for non surgical procedures and anything that does not leave a scar attracts them. They usually do not want people to know that they have undergone  a procedure and non surgical rhinoplasty is a god sent for them. At present the fillers used are imported from European countries and are prohibitively expensive.  The cost increases significantly in the long run as this procedures has to be done almost every year.
With the increase in trained physicians who can undertake the procedure and the easy availability of fillers this procedure would be more commonly enquired about and undertaken.
12) What is the future of Non-invasive Rhinoplasty in India?
The future is very good if undertaken by well trained physicians who know how to treat the complications in case one arises. The greatest risk is that of blindness and loss of skin in the injected area which can be reduced substantially by the use of this modern technique of injection under vision.


By: Dr Mohan Thomas Senior Cosmetic Surgeon, Cosmetic Surgery Institute

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