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Refining the nose with a needle

Article-Refining the nose with a needle

Dr. Kontis

Word is getting out. People scouring the internet to learn about nose jobs are discovering that it’s possible to change the look of their noses nonsurgically with fillers, says Theda C. Kontis, M.D., who coauthored “Nonsurgical rhinoplasty,” published October 2016 in Facial Plastic Surgery and is presenting on the topic at the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) Advances in Rhinoplasty Meeting in Chicago from May 4 to 7, 2017.

“Before now, it didn’t even have a name. Now [nonsurgical rhinoplasty] is becoming popular when people see there’s a sort of ‘cheat’ rhinoplasty that they can do,” Dr. Kontis tells Cosmetic Surgery Times.

Nonsurgical rhinoplasty appeals to many who can’t afford the expense or time off associated with surgery; people who have already had a rhinoplasty but imperfections remain; and older patients who don’t want to endure surgery.

The nasal dorsum was filled with Restylane in the nasion and supratip areas to camouflage the dorsal hump. The tip was also lifted slightly and refined with filler. Approximately 0.3cc of Restylane was used. The after photo is immediately after the procedure. Photos courtesey Theda C. Kontis, M.D.

Selfies have put noses under the microscope, Dr. Kontis says, and patients, armed with selfies, are coming to her office pointing out exactly what they’d like to change.

“People are paying much closer attention to their appearance and focusing on the things that are bothering them,” says Dr. Kontis, a facial plastic and reconstructive surgeon and assistant professor in Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Md. “They’re also understanding that nonsurgical rhinoplasty is a technically difficult thing to do. I don’t know this for a fact, but I don’t think that they are going to spas and novice injectors for this. I think they know it has to be done by a physician.”

NEXT: What Fillers Can and Can't Do


What Fillers Can and Can't Do

Filler can’t make a big nose smaller; nor can they refine a bulbous nasal tip, according to Dr. Kontis.

What fillers really do for the nose is camouflage. So, for a dorsal hump, filling on either side of the hump can improve the look of the nose. A crooked nose that’s c-shaped — concave on one side — should look better after the injector fills the concave side. And, while one can’t really refine the nasal tip because fillers have mass, injectors can use fillers to slightly elevate the nasal tip, she says.

To achieve optimal outcomes in nonsurgical rhinoplasty, Dr. Kontis’ fillers of choice are either hyaluronic acid or calcium hydroxylapatite. Specifically, she uses Restylane (Galderma) or Radiesse (Merz Aesthetics).

“Restylane is probably my go-to product because it’s soft, it gives good elevation and, if I run into a problem, I can dissolve it,” she says.

Dr. Kontis says she might go to Radiesse for someone who doesn’t want to come in six months or so for a touchup. Radiesse lasts about a year in the nose, she says.

NEXT: Nasal Injection Tips


Nasal Injection Tips

The most important thing the provider must do during a nonsurgical rhinoplasty is inject into the right plane, according to Dr. Kontis.

“We need to be in the plane just above the periosteum or perichondrium. If you’re more superficial to that, you risk vessel embolism or occlusion, which can cause tissue necrosis and even blindness,” she says.

Only small amounts of filler are needed for nonsurgical rhinoplasty.

“You would never use a whole syringe of product in the nose. You use little, tiny amounts. I put a little in and massage it into place; inject a little more and massage it; and just go very slowly until I get the result I want,” she says.

Also, be careful because you’re filling into a soft-tissue envelope.

“You don’t want to inject so much product that you increase the pressure on the skin which could also decrease the blood supply and result in tissue necrosis,” Dr. Kontis says.

Dr. Kontis says she uses only a topical anesthetic because patients tolerate the procedure very well. And after the nonsurgical rhinoplasty, patients note instantaneous results and can return to their normal routines.

Dr. Kontis also uses fillers to nonsurgically address nasal valve breathing problems.

“If you think about fillers being like a cartilage graft, you can pretty much do with fillers what you do with cartilage. So, when people breathe in and one nostril collapses because it doesn’t have enough support, you can use filler as a structural graft to support the ala,” she says.

Her filler choices when addressing nasal valve problems are the same: Restylane and Radiesse.

“The internal valve is inside the nose where the septum up high meets the sidewall of the nose. It makes a narrow V-shape. Surgically, we perform nasal valve surgery, where we put in grafts called spreader grafts. Filler is supportive enough to act like a spreader graft. It can be injected into the lateral aspect of the internal valve to stent it open, so it doesn’t collapse when the patient breathes in,” Dr. Kontis says.

Disclosure: Dr. Kontis is an injector trainer for Galderma and Allergan.

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