Question: I have had a dent on my nose for the past five months. My rhinoplasty was a year and a half ago. The surgeon recommended Restylane, but that is not permanent. What other options do I have?
Answer: I think Restylane in that circumstance may be a very good option if it is a very small dent and the risk of performing any sort of revision surgery is outweighed by the mild nature of the deformity. If you are extremely interested in the longer lasting result then injection of Radiesse may last up to two years or even longer in certain individuals. And as a last resort, you could consider injection of silicone into that area, though it is certainly not FDA approved as an injectable filler. Other considerations would be to perform a rather minor surgical procedure in the office where a small amount of cartilage is harvested from the back side of the ear and then, through a relatively small and precise incision, a pocket is made in the area of the depression and this cartilage is placed within it. I have performed this on a handful of my own rhinoplasty patients with excellent results, and it does not demand a trip to the operating room.
In my opinion there really is not a good way to nonsurgically fix the nasal dorsum after two failed rhinoplasties. Unfortunately I truly feel that a proper revision rhinoplasty performed by an experienced rhinoplasty surgeon will give you the best long term result regarding your nasal appearance. With that said if there is only a small depression that is the main problem, one can certainly perform an injection of filler material into this area and at least temporarily resolve the issue. I strongly caution patients about having any sort of a permanent injectable material placed in any part of their bodies due to the fact that products such as silicone or methylmethacrylate truly are permanent and we really do not know what this will mean ten, twenty, thirty, or more years from now. Temporary materials such as Restylane or Juvéderm certainly can help camouflage some irregularities on the nose and I feel are a perfectly acceptable solution to the problem, but obviously the problem will persist once the filler material is gone and I recommend revision rhinoplasty at some point in the future as a permanent solution to the problem.
Yes there is. Botox or Dysport can be used to relax the muscle at the base of the nose and in the upper lip called the depressor septi muscle that can pull a nasal tip down. Only a certain percentage of patients actually have this muscle, but is a patient does have strong activity in this muscle and a droopy tip, the relaxation of this muscle can elevate the patient’s tip slightly. Overall the effect is relatively subtle, but certainly very much appreciated by the patient who has this. Obviously due to the fact that the treatment is Botox or Dysport, the result will only be temporary. A permanent solution to this problem would be a form of rhinoplasty and I would recommend that anyone interested in a more permanent solution seek someone with a very significant amount of rhinoplasty experience as rhinoplasty is one of the most difficult cosmetic operations to master.