Permanent Non-Surgical Rhinoplasty

No, the essence of the procedure is using micro-droplets placed just beneath the skin. The droplets are immediately walled off and trapped by nature’s healing process. Nor is the effect like a solid implant in which some potential for movement exists.

Yes.

Yes, there is always a possibility of infection with any procedure, but not likely.

The cost of Permanent Non-surgical Revision Rhinoplasty or Permanent Non-surgical Rhinoplasty is generally 25% of the cost of an average surgical rhinoplasty. Unlike the temporary non-surgical option, where there is uncertain and likely non-ending cost to replace the absorbed nose filler, the cost of the permanent treatment is fixed. One fixed fee.

Unlike a majority of nasal surgeons, Dr. Kotler’s Permanent Non-surgical Revision Rhinoplasty results are truly instant. You can expect to see mirror-in-hand rhinoplasty results with little to no touch-ups required.

The recovery process for permanent non-surgical rhinoplasty is fast and easy. Once our clients leave the office, they’re able to resume all activities without discomfort, swelling or bruising. 

Performed with local or topical anesthesia to minimize potential pain, the entire treatment usually lasts between 10 to 20 minutes, and patients can resume daily activities after their procedure.

Non-surgical rhinoplasty is the correction of nasal imperfections without surgery without downtime or side effects. It is an office treatment using medications that can either fill dips, divots, depressions, and asymmetries. Also available are “shrinkers,” which can often shrink some of the swollen tissue and, therefore, positively accentuate the somewhat hidden architecture.

Most non-surgical rhinoplasties are temporary due to the fact that almost all the practitioners have been trained and educated only in the use of absorbable fillers. Restylane^® and Juvderm are the best-known injectable dermal fillers, albeit temporary. While there is variety, they all have a timeline and ultimately will disappear. Only one product has professional recognition and FDA approval to be described as “permanent.” The only permanent non-surgical rhinoplasty is the use of medical-grade liquid silicone to correct those bumps, divots, irregularities, and asymmetries. It is excellent for correcting a pinched tip and an over-sloped nose. Indeed, it is permanent.

Non-surgical or temporary rhinoplasty employs materials that are absorbed by the body over some period of time. Manufactured hyaluronic acid is the most common dermal filler.   They cannot claim to be permanent. Patients are happy to have the improvement, but on the other hand, there is a negative need for lifetime replenishment.

The changes brought by the temporary absorbable dermal fillers are indeed temporary. The body degrades these. It may take place over months or occasionally over a couple of years, but ultimately, the benefit of the temporary filler is lost. The only way to renew the benefit is to have another series of injections

Permanent non-surgical rhinoplasty is a well-established and highly successful office treatment to correct certain external nasal imperfections. The liquid filler rhinoplasty “plumps up” one or more areas where there is too little bone or cartilage from birth or those dips, divots, potholes, and unnatural elements that followed one or more unsuccessful rhinoplasties. For the population frustrated with successive failure after failure after failure of surgical rhinoplasty, this becomes renamed the “Rescue Rhinoplasty.”

The ultimate permanent nose job is the surgical nose job. This is a safe and venerable procedure that typically is ideal for noses that have an excess framework. Perhaps there is a bump, a tip that is too bulbous, a nose that hangs down too long and depresses with a smile, or a nose that is too wide and crooked. There may or may not be breathing issues, either. The operation has been done for over 100 years and, in the hands of sophisticated superspecialists, has a very high success rate. 

The other permanent nose job is a permanent non-surgical nose job. It is not a substitute, per se, for a surgical nose job, but it may be quite appropriate when the imperfections are relatively minor. Typically, someone with a very small bump or a somewhat drooped tip. Augmentation of the tip will raise it and give a better profile. Likewise, placing filler “above” and “below” the bump will essentially hide it, and generally, the patients are very satisfied with this technique.

The ideal candidate for non-surgical rhinoplasty is someone who has never had a prior rhinoplasty. That would be the patient who has a small bump that can be concealed, a tip that may be droopy, a slightly over-shortened nose whereby injecting filler below the tip will draw the tip forward, and a little bit of asymmetry and crookedness can be filled to even out the two sides. This of this as filling a divot or pothole or trench. It is far more predictable, accurate, and more reliable than a surgical procedure. Likewise, the cost is considerably less.

A patient is not a good candidate for injectable fillers if their nose is very large. After all, the permanent non-surgical rhinoplasty adds volume. It is a filler. It is best for a very lean, thin, and obviously imperfect nose. Those who have a large nose, to begin with, will not be satisfied when the volume of the nose is increased by the permanent filler.

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No procedure is ideal for all patients. Since the non-surgical rhinoplasty procedure is  a dermal filler, it is an “addition” to the nose. When a plastic surgeon performs a traditional rhinoplasty, it is generally a “subtraction” process. Some bone and or cartilage is removed. For one with a large nose, while capable of obscuring minor imperfections, the liquid rhinoplasty will yield a net increase in nose volume, which may not be appropriate.

Permanent non-surgical rhinoplasty in experienced hands is extremely safe. These are tiny micro-droplets injected through a nearly invisible needle. There is little risk of piercing a blood vessel when the injector understands the anatomy of the nose. A very reliable technique prevents the chance of accidentally entering the inside of a blood vessel. Some bleeding and consequences are rarely an issue. You see the results immediately, and while there is a progression that takes place over several months because the medication needs to be layered in over 2 or 3 sessions, you leave the office with a better nose than you walked in with.

Before non-surgical rhinoplasty, the only activity is that an anesthetic ointment is applied to the nose 45 minutes before the anticipated treatment session. This anesthetizes the skin and makes the puncture of the skin by this tiny needle nearly painless. By applying the medication 45 minutes before the office appointment, there is little waiting time in the doctor’s reception area.

Your nose job consultation should include an examination of the inside of the nose. This is done to evaluate the breathing and internal structure. It evaluates the potential for improved breathing if one indeed has difficulties. Then, the outside of the nose is evaluated by inspection and feeling to test the strength of the cartilage and the mobility of the skin. One needs to see the position of the nose when smiling. It only takes a few minutes to size up the situation and decide if surgical rhinoplasty is an appropriate technique. 

Conversely, many patients seek permanent non-surgical rhinoplasty. In that case, the same examinations are done, and the question that must be answered is whether or not the permanent non-surgical route is more predictable and preferable from all aspects, including time away from work, cost, longevity, and predictability. 

The non-surgical rhinoplasty, the so-called “liquid rhinoplasty,” is the injection of a dermal filler through the skin into the thin space between the skin and the underlying rigid frame composed of bone and cartilage. It is a “plumper”. By such inflation, the plastic surgeon is creating an illusion that the underlying framework’s imperfections have been positively altered. The result is not obvious to the eye nor to feel. It is the most simple and direct way to alter appearance without plastic surgery.

The skin is anesthetized using a topical anesthetic. Employing a special cannula, the injectable filler is deposited between the skin and the underlying bone and/or cartilage. It can be injected into the tip or bridge, the two main regions of the nose. The result is immediate. Temporary injectable fillers such as Restylane^® and Juvéderm^®, composed of hyaluronic acid, a compound that exists in the skin and cartilage, correct the imperfections in one session. Distinct from these temporary dermal fillers is medical-grade liquid silicone, marketed as Silikon-1000, which is the sole permanent filler. When this product is employed, multiple micro-droplets are injected. Also, the process is typically conducted during three sessions to allow Nature to best accommodate and wall off the filler in the injection location to prevent dissipation into adjacent areas.

By using an anesthetic cream applied to the nose 45 minutes before the appointment time, the procedure is quick and virtually painless.

There are no consequences of having the office treatment. You leave the office and resume your life. There are no constrictions other than advice to not rub the nose since once the liquid material is placed under the skin; nature likes to have quiet and non-disturbance. Typically, there is a six-week interval between the first and second and then subsequent treatments. This gives nature the timeline to accept the material, form a microscopic wall about it, and thereby maintain its position.

Recovery takes as long as it takes to leave the office.

The duration of a non-surgical nose job depends on whether it is temporary or permanent. Those are the two main categories. 

A temporary non-surgical nose job has a certain lifespan. Various manufacturers distribute the different products. They often have different missions for different locations since those products are used in other areas other than the nose. The duration is not always certain. 

On the other hand, if you are having a permanent non-surgical nose job, it is forever. 

If you are not happy with the appearance of your nose and or the breathing, you need to see a specialist. Family doctors and internists are of little help because they are not surgeons. The cosmetic nasal surgeon who works in nearly or exclusively rhinoplasty should be at the top of your list of consultants. The “superspecialist” will generally have a computer imaging system to show you the predicted result. After all, shouldn’t you see the expected outcome?

After rhinoplasty, sometimes there are minor imperfections. Rather than submit to another surgical procedure, often a non-surgical revision rhinoplasty is preferable. Typically, four to six months after the procedure, imperfections or minor asymmetries are noted, and that is the appropriate time to institute the non-surgical revision rhinoplasty. Whether one opts for the temporary or permanent, the timeline is the same.

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Treatment should always be performed by the most experienced, most specialized practitioners. There is no substitute for experience, and there is no substitute for narrow focus.

The rules for choosing the ideal non-surgical rhinoplasty practitioner are simple. Decades of experience, a high degree of specialization, and proven results based on before and after photographs and patient testimonials. It is that simple.

Dr. Kotler pioneered the Kotler saline demo. This is a “test drive” or “sneak preview” of what the result of a permanent non-surgical rhinoplasty or permanent non-surgical revision rhinoplasty would look like. Sterile saline is injected into all the areas that would benefit from filler. The result is immediate. The patient judges the result by looking in the mirror. Photographs are taken before and after. This allows comparison in the comfort and quiet of one’s home as to whether or not the predicted result would be satisfactory. It is extremely important, particularly for people who are either skeptical that this is a reasonable substitute for surgery or have had so many surgeries that they find it almost astonishing that this relatively simple technique and salvation has never before eluded them. 

Another pioneering achievement by Dr. Kotler is as an inventor. Dr. Kotler invented the Kotler Nasal Airway™ and the Roltok Clear-Flo™ ultra-smooth nasal septal splint. These are used in surgery by nasal surgeons. The septal splint helps stabilize some of the reconstructive aspects when one has had an operation for a deviated nasal septum. The Kotler Nasal Airway™ can be used in all nasal cases, cosmetic or functional, and any and all sinus surgeries. The device is a double-tubed airway or bypass that sits on the floor of the nose and allows air to pass through the nose, even though the nose may be unpacked, meaning no gauze or telfa, or any other material is placed. The objective is very simple: To allow the patient to breathe and therefore avoid some of the postoperative dissatisfaction and discomfort when, in addition to some of the other minor burdens of recovery from surgery, there is blockage of the nose and often some congestion of the ears. The device is FDA-cleared, patented, and has been used in over 30,000 cases in the United States and other countries.

Pain is not an issue because we have a large variety of effective pain medications. Recovery depends on the procedure but may be as short as five days with respect to looking good and returning to work or up to ten days, particularly if reconstructive surgery for breathing and allergies was done. 

The days of massive swelling and bruising of the face should be gone because better surgical techniques done by more sophisticated, more specialized, and more experienced surgeons, plus the use of modern medications such as platelet-rich plasma and tranexamic acid are all joining forces to reduce the visual consequences and accelerate healing.

While the non-surgical rhinoplasty procedure is very successful for correcting external imperfections following the first or subsequent surgical rhinoplasty, not all points of dissatisfaction are curable by the liquid rhinoplasty alternative to the traditional rhinoplasty. Most often, the nasal passages have been adversely affected by prior surgery or surgeries, and this requires revision internal surgery. A deviated nasal septum may be the significant culprit. The septum, cartilage up front and bone further back, is the vertical partition between the two nasal passages that may cause nasal obstruction. If the nose is very crooked, there is a limited role the non-surgical rhinoplasty can play. Surgery may be required.

If one has a temporary filler, the nose will go back to normal because the filler will be digested by the body. If one has permanent non-surgical filler, indeed, that result is unchanging for the rest of one’s life.

The rules for nose filler do not do it in the face of any infection. Those who are on certain medications, such as chemotherapy, which can alter the body’s acceptance of the manmade material, are best avoided. It is not always possible to inject some areas because of scar tissue causing adherence of the skin to the underlying cartilage. Other than that, there are very few restrictions. It is a matter of the patient’s choice, the patient’s taste, and the patient’s desire.

For nearly 60 years, there has existed one permanent nose filler, medical-grade liquid silicone. It is marketed under the name Silikon-1000.  This is the gold standard for fillers. The body accepts medical-grade liquid silicone just as well as it accepts the brother products, which are solid. These include artificial heart valves, artificial joints, pacemakers, and all tubes and catheters that are placed within the body. Silicone is one of the biomedical industry’s greatest achievements.

The only avoidance after nose filler is to avoid running the nose. Nature likes quiet. It wants peace. It wants to incorporate the produce into the tissues. Normal face washing is fine. Just no massaging or facialist-induced squeezing of the skin of the nose.   Such restrictions are not forever. Only during the period of ripening and maturation, which ends six weeks after the last treatment

You sleep as you do normally

There is no vitamin, medication, cream, capsule, or anything else to reduce the volume of the nose. The only reliable method is the classical rhinoplasty or nose job.

The patient has options. If they wish to have a temporary filler, they certainly can. If they want permanency of the process, then that is an easy decision. The patient can choose the medical-grade liquid silicone, which is permanent. The irony is that most people having the temporary are not aware of the existence of the permanent. The reason for that is the temporary filler industry is enormous. The same filler is used in other parts of the face, and therefore, the market is huge. Physicians are heavily marketed to by major corporations. These corporations have enormous advertising and marketing budgets and easily win the hearts and minds of doctors and nurses, physician’s assistants, and nurse practitioners, all of whom are anxious to provide that service.

The best guideline for age for liquid rhinoplasty is the same as it is for surgical rhinoplasty. Typically, for young ladies, it is 15 to 16, and for young men, it is 17 to 18.

This is an excellent question. The answer is that you can. The non-surgical treatment incorporates the filler material into the skin. The skin is raised during the course of surgical rhinoplasty, so from the standpoint of the end result, it is irrelevant to having the filler.

Silikon-1000 is the trade name for medical-grade liquid silicone.

That is a very wise question. The answer is no. Temporary fillers are incorporated into the tissues, but these blood supply and other factors of normal skin are not the same. When a permanent filler is placed into an area where there is temporary filler, there does not exist the body’s natural process to accept it, incorporate it, and make it permanent. This is why we always ask whether people have had temporary filler. We want to know when it was placed. We want to know what product it was. The good news is that if you have a temporary filler and would like to “switch over” to a permanent filler, most of the temporary filler can be dissolved using a specific prescription medication.

Most people choose a permanent filler for the reason that it is permanent. They do not want a lifetime sentence of temporary fillers.

It is very rare to have an allergic reaction to the temporary fillers because they are actually composed of, in the main, a material that is actually present naturally in the body. As far as an allergic reaction to the permanent filler, it would be very, very rare yet possible. Those people who are “hyper-reactors” would be well served to have a small test whereby a tiny drop is placed behind the ear, and for six weeks, we look for any signs of reaction.

If the end result of the treatment makes the nose look bigger, then it was not a well-founded decision to use it. The idea is to use it in areas where the imperfections are concealed. Yes, by volume, the nose size is increased, but the offset is the far less obvious improvement of the imperfect features.

One should ask the question first, which non-surgical nose job filler will be used. Many years of temporary fillers will significantly raise the cost and perhaps equal that of surgery. On the other hand, permanent non-surgical rhinoplasty or permanent non-surgical revision rhinoplasty is a fixed cost, which is typically 20% to 25% of that for surgery.

If you consider using fillers as “reshaping,” then the answer is yes. The question is, is it proper? Is it appropriate?

The longest-lasting filler for the nose is the only permanent filler, medical-grade liquid silicone marketed at Silikon-1000. It is, indeed, with you throughout your life.

The nose can be made thinner only by surgery. On the other hand, the illusion of the nose being thinner can often be achieved by skillful filler placed over the bridge of the nose in the midline. By raising the bridge in the midline and even by raising the tip in the midline, the illusion of the nose being narrower is achieved.

The charges of the temporary liquid rhinoplasty are based on the volume of the material. This is commonly known as “how many syringes” of the product are pre-prepared and packaged within a syringe. Permanent non-surgical rhinoplasty or permanent non-surgical revision rhinoplasty using medical-grade liquid silicone operates under a somewhat different framework. The volumes used are so small, and the differential between just a couple more hundredths of a cc is so important that it is best to customize the treatment and disregard the volume used. The fees are based on the surgeon’s time, talent, and the cost of the material rather than purchasing the temporary filler, which is a commodity and for which the charges vary considerably.

While it is impossible to make the optimal reduction of a bulbous tip, by filling the dome of the tip with filler, you arrive at the illusion of a narrower tip.

That is the great question that every consultation answers. This requires a thorough examination after a history of surgeries, as well as evaluation of breathing issues. There are a lot of factors that go into the decision, but the most important question is which is more likely to achieve satisfaction with one surgery or one series of filler, and that takes considerable thought and discussion with the patient.

Yes. It is an excellent alternative to surgery. Surgery would require the placement of either a plastic part or a shaped piece of cartilage taken from the nose, the ear, or the rib cage. A filler is infinitely simpler, more predictable, and obviously less time-consuming and less expensive.

Dermal fillers can be the ideal solution. This is where the non-surgery rhinoplasty procedure can really be a hero. Whether from accident or even congenital, the indent can be plumped by the injectable filler material. A la” Bondo,” the cure for an automobile body dent. With no side effects, no downtime, and a natural result at far less cost, the non-surgical alternative relegates the traditional rhinoplasty to the “not the best answer” category.

Liquid rhinoplasty, particularly the silicone permanent variety, is very cost-effective. These office procedures, with an immediate result, no downtime, no surgeon fee, no operating room or anesthesiology specialist expense, and little risk of side effects or complications from the surgery itself or the anesthesia, are most often declared “worth it” in public posting on review websites. It should be noted that the most satisfied patients are those who had the permanent filler, not the temporary filler, because the latter implies a lifetime of treatments. Conversely, the permanent filler treatments, when the limited number of sessions are completed, are finite. Therefore, there is no recurring and constant cost of renewing the temporary dermal filler.

Typically, some of the imperfections and, therefore, unsatisfactory portions of the result of surgical rhinoplasty can be corrected by a liquid nose job. However, not all of the defects and inappropriate features are correctable by injectable fillers. Typically, these dermal fillers are most appropriate for those areas where too much bone or cartilage have been removed, leaving the bridge too low, one or more side too narrow, the nasal tip too “pinched,” the nostrils asymmetrical, the nose appearing too “upturned.” But that’s a generous menu, so many people will be candidates for the often ideal alternative to yet another surgery, the liquid nose job.

It would be very rare. The reason is that the filler should be placed deeply under the skin with little influence on the direct level that houses the capillaries. Should that occur, the capillaries are easily managed by focal precision laser treatments.

Non-surgical rhinoplasty is indeed non-surgical. It is done in an office setting and requires little preparation. There is no recovery time. Surgical rhinoplasty typically can address a lot more problems, including breathing problems, but it is an operation. It is conducted in an outpatient surgery center under anesthesia. There is a seven- to ten-day recovery period. The costs are significantly different. An ideal result from a surgical rhinoplasty cannot be warranted, and therefore, for some patients, it is necessary to have a revision rhinoplasty. At that point, the question should arise as to whether the revision should be a temporary non-surgical revision rhinoplasty or a permanent non-surgical revision rhinoplasty.

No, it cannot. Functional issues are due to malpositioned internal nasal structures. There is no non-surgical remedy for these. The surgical remedies, which can be performed at the same time as a cosmetic rhinoplasty, are very successful.

Sometimes it can, and sometimes it cannot. By itself, it certainly cannot correct breathing issues. It cannot correct certain major asymmetries. It cannot correct certain congenital abnormalities. We have to pick and choose which modality is better, surgical or non-surgical, and then if non-surgical, permanent versus temporary.

In reality, yes, because it is an “add-on.” It is an addition. The art of it is using it to conceal imperfections such that the volume increase is not obvious. 

The illusion of narrowing can be achieved, but only when the filler is used only in the midline and over the bridge of the tip. Any placement of the filler laterally on the sides of the nose will make the nose look wider.

The plastic surgeon should take a set of “Before” photos. Following the conclusion of

For the non-surgical rhinoplasty treatments, another set of photos, in identical views, should be taken. These are available to the patient and are a part of the office record. During the course of the liquid rhinoplasty treatments, the doctor can refer to the photos as an objective guide to the areas needing correction/improvement. A practice that is very specialized in this process will have many examples on its website, in both cases, where the liquid rhinoplasty was the sole corrective procedure in lieu of surgery or where the non-surgical rhinoplasty was the alternative to a revision rhinoplasty or rhinoplasties.

9735 Wilshire Boulevard, Suite 220, Beverly Hills, California 90212, in the Golden Triangle of Beverly Hills, one of the world’s most sophisticated medical communities with a strong presence of superior practitioners within the field of cosmetic procedures.