News & Features

Revision Rhinoplasty

Need a 2nd Nose Job? Consider Injections!

by Robert Kotler, MD, FACS

Not all surgical procedures need to be done via surgery. Some plastic surgeons can reshape the nose -- or repair a botched nose job -- with injections.

Syringe Injector Used For Rhinoplasty Injections

According to the American Society of Facial Plastic and Reconstructive Surgery (ASFPRS), up to 25 percent of rhinoplasties do not produce good results, and can leave a nose with unsightly grooves, depressions or even some crookedness. Some may also have an overdone look, heralded by a pinched-tip or over-scooped profile.

Even in the very best of hands, five to 10 percent of rhinoplasty patients can require another trip to the operating room. Nasal surgery is one of the most technically demanding and complex procedures on the roster of cosmetic procedures. That's why some experienced specialists say it requires performing somewhere near 150 cases over several years to really get a handle on performing the operation.

Costs of Plastic Surgery

"A series of silicone injections to the nose usually costs between 20 to 25 percent of the cost of a surgical revision."

When nasal surgery must be redone, traditionally, cartilage - or even bone - is transplanted from within the nose or from elsewhere in the body. Such complicated revisions are also expensive and can cost more than the original procedure. Plus, you must consider time away from work and some discomfort.

Many years ago, I learned a non-surgical injection technique from Dr. Jack Startz, an innovative, senior Beverly Hills cosmetic facial surgeon. He showed me how to repair bungled rhinoplasties in two to five office visits. The technique involves no incisions, no time off work and no recovery downtime.


Before I explain more, I would like for you to open your mind and not react to a word that is emotionally loaded. That word? Silicone. A marvel of modern chemistry with a 50-year safety and efficacy record, yet unfairly decried and vilified by the media and other unenlightened sources.

"Even in the best of hands, five to 10 percent nose surgery requires another trip to the operating room."

In point of scientific fact and despite the misinformation you may have heard, silicone has long-proven to be practical, reliable and safe. No bonefide scientific evidence ever linked silicone to health problems. For decades, artificial joints, heart valves made of solid silicone have passed the test. Every hypodermic needle is coated with a thin layer of liquid silicone for a smooth entry into body tissue. Recently, the FDA approved silicone-filled breast implants. Finally, the ultimate standard for safety: Liquid silicone is FDA-approved for injection into the interior of the eyeball to reposition a detached retina.

Raise the Bridge of the Nose

But, getting back to how I use this superb product of modern science, I can inject tiny micro-droplets of liquid silicone under the skin of the nose, in the space between the skin and the underlying bone or cartilage, to plump up those divots, depressions and troughs. I can raise the bridge of a ski-slope nose or fill out the side of the nose where a previous overly-aggressive surgery has removed too much tissue, causing it to sag or collapse.

Syringes Used For Cosmetic Injectables

The human body forms a thin capsule of scar tissue around the micro-droplets, walls them off to prevent dissipation and migration. So silicone nasal injections are permanent. A big plus. While there are other injectables -- currently used to plump lips and fill out the marionette lines around the mouth -- none are permanent.

First Nasal Surgery

In addition to those whose original nasal surgery - or even surgeries - went awry, even those who are considering nasal surgery for the first time may qualify to have the injections in lieu of surgery. For some others, both surgery and injections may be necessary to achieve the optimal result,

particularly if breathing is impaired.

Injection Rhinoplasty Before and After Photos
A 29-year-old woman was sent to Dr. Kotler by a distant surgeon who
had trouble aligning her nasal bones while doing a cosmetic rhinoplasty,
top. In the bottom photo, a series of silicone injections has filled the
depression on the left side of the woman's nose without additional
surgery. (Dr. Kotler photo.)

Cost considerations also favor injections, when appropriate. A series of silicone injections to the nose usually costs between 20 to 25 percent of the cost of a surgical revision.

Here's another plus: The patient can see the results immediately after injection and can participate in the decision about how much needs to be added.

For the skeptical or to help the patient appreciate the end-result that injections can achieve, I offer a practical "demo". With the patient holding a mirror to see exactly how the injection is conducted, I inject ordinary sterile salt water. Of course, the salt water is later absorbed by the body, but at the demonstration, the prospective patient sees the predicted result and can then have a very clear image of what the nose will look like following the series of injections. The mystery is erased.

Here are the points I share with patients who come to see me about having a corrective nasal surgery:

Injectable liquid silicone offers:

Certainty of outcome. What you see is what you get.
Contrast that with surgery, where the exact outcome is never certain and where the healing period can be as long as a year.

A two-minute office procedure.
You can immediately go back to work with no visible signs of treatment, swelling, bruising or pain.

Patients decide the end point.
If you want more change, we can do it immediately.

Minimal discomfort.
Anesthetic cream is applied onto the skin of the nose before the injections. The needle is very fine and short.

You must be thinking at this point, "If the procedure is good, and an excellent alternative to more expensive surgery, why don't we hear more about it?"

Cosmetic Surgeons

Nose Close-Up

Good question. First, very few cosmetic surgeons have had the proper training and experience necessary to deliver superior results. Second, surgeons have a natural bent for performing surgery; that's what they do in life. Plus, the plain truth is that -unfairly and inappropriately -- many people react badly to any mention of silicone. They immediately shut off when the word is heard.

Finally, don't take my word for it. To appreciate the great role and value of these silicone mini-injections, just ask a satisfied patient and look at photos of typical case histories. Then, you'll

"get it".

About Dr. Kotler: Robert Kotler, MD, FACS, a Beverly Hills cosmetic facial surgeon, has been in practice for 30 years. He is a clinical instructor at the UCLA Medical Center and is the author of two category best-seller books on cosmetic surgery for consumers. You probably saw him as the voice of experience on the premiere and second season of the TV reality program Dr. 90210.

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