Complications of non surgical nose job

[maria]

Hello Doc Bermant, I got a non surgical nose job to try out the results before going through with the surgical option. From a couple of traumas nose is structurally weak and deficient in the lower half. Volume was added along the right sidewall and down towards the tip and a curvilinear depression on left side of tip was filled out. The injections were done from inside of nose. Wanted to know would the needle trauma to the inner side of a weakened nose have a negative impact on the nasal components/tissues and is there a risk of permanent deformity from such a maneuver. Thank you

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[DrBermant]

Hello Doc Bermant, I got a non surgical nose job to try out the results before going through with the surgical option. From a couple of traumas nose is structurally weak and deficient in the lower half. Volume was added along the right sidewall and down towards the tip and a curvilinear depression on left side of tip was filled out. The injections were done from inside of nose. Wanted to know would the needle trauma to the inner side of a weakened nose have a negative impact on the nasal components/tissues and is there a risk of permanent deformity from such a maneuver. Thank you

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Welcome to our forum.

A "Non Surgical Nose Job?" Now that sounds like a possible marketing phrase, not something I ever tried or would consider doing. But to evaluate such claims I would use the same criteria from our resource How to Pick a Plastic Surgeon. I have been working on the subsections, and hope to get to the How to Choose Your Rhinoplasty Surgeon some day. They would be based on Standard Rhinoplasty Pictures or possibly more issues specific to nasal surgery like discussed on this post Re: Collapsed nose due to Cocaine use.

There are valid non surgical options for nasal problems like acne scars, where collagen or dermal fillers some like as a treatment option. I did not like the permanency issues to offer that for my own patients.

One important issue for evaluating a non surgical option, can that doctor offer surgery?  Do they have hospital privileges in that operation?  What Board Certifications do they have? Here is something I used to check doctors I was seeing complications from the American Board of Medical Specialists:

http://www.certificationmatters.org/is-your-doctor-board-certified.aspx

I did offer non surgical options such as Non Surgical Body Shaping Garments which were an immense asset for my patients who were trying to stabilize their problem or wait until they could afford surgery, or the right time of year. The difference, is that option had careful documentation of before after pictures and I could offer surgery and demonstrated the options each way with critical documentation. 

But back to a "Nose Job."  When I was still in practice evaluating unhappy patients after surgery done elsewhere, the starting point is

What was the original problem?
What sort of trauma happened before? Some Nasal Fractures can leave parts of the nose stronger with the healing process, other problems can weaken, just depending also on many factors.
What was done?
What was the individual unhappy about?
What was my exam of the tissues like?



Some of the unhappy patients I saw had silicone nasal injections, silicone implants, other implants like gortex, acellular matrices of various types, cadaver dermis, and a whole slew of different substances.

The basic problem I saw that was not well documented by most proponents was the airway. To push out, any material put between the skin and the cartilage must push back in. This is usually not a factor when referring to the dorsum and support by the underlying septum framework. However, I saw complications when even that support was buckled when trying to convert a flat nose into a projecting one like an Oriental to Caucasian modification. But for the critical internal valve of the nose, it takes so little to destroy the airway. The tip support is somewhere between. I have seen even surgical attempts at projection disrupt the support system. Careful before and after pictures and measurements were the best I was able to come up with before my practice evolved away from Rhinoplasty sculpture.

Now what happens if a supporting system is weakened from some injury, event, surgery, or what ever?  Too many factors to be able to prove one way or another. We all get swelling from trauma. That distorts the nose. But minimizing the amount of the swelling and length of time probably lowers the probability if the effect being permanent. What about longer effects of a material that is mostly gone after x months? Again, who is able to document the changes?  How critically are they showing proof that the nose returns to the prior state? Again, I did not see enough proof to offer it.

I did offer structural changes using cartilage grafts and suture to get living tissue to continue the shape. I did like what I saw others showing me to offer that type of Rhinoplasty. But for permanency, my patients were cautioned about the fickle nature of the nose and its cartilage framework. Use this site's search engine and you will see that phrase all over the Encyclopedia and forums. That is the nature of the material.

For my patients I preferred using my computer drawings during my Rhinoplasty Consultations to discuss the range of what surgery might offer. But the beauty of about the thinking mind, is that whatever I was doing, I was looking for something better. I have yet to see a "non surgical nose job" that I was willing to offer. But time are a changing and perhaps something will become available. I like the idea of structural shape Reconstructive Ear Otoplasty Forum - Building Ears With 3D Printing Progress. Something that can tie into real current support or provide new support on its own But these are structural frameworks that are hopefully going to be built out of our own body's cartilage, a living support system, that my guess will be a surgical sculpture.

Back to your problem. Why not post before pictures and after pictures?

Hope this helps,

Michael Bermant, MD
Learn More About Rhinoplasty, Septoplasty, and Sculpture

[DrBermant]

Hello Doc Bermant, I got a non surgical nose job to try out the results before going through with the surgical option. From a couple of traumas nose is structurally weak and deficient in the lower half. Volume was added along the right sidewall and down towards the tip and a curvilinear depression on left side of tip was filled out. The injections were done from inside of nose. Wanted to know would the needle trauma to the inner side of a weakened nose have a negative impact on the nasal components/tissues and is there a risk of permanent deformity from such a maneuver. Thank you

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Welcome to our forum.

A "Non Surgical Nose Job?" Now that sounds like a possible marketing phrase, not something I ever tried or would consider doing. But to evaluate such claims I would use the same criteria from our resource How to Pick a Plastic Surgeon. I have been working on the subsections, and hope to get to the How to Choose Your Rhinoplasty Surgeon some day. They would be based on Standard Rhinoplasty Pictures or possibly more issues specific to nasal surgery like discussed on this post Re: Collapsed nose due to Cocaine use.

There are valid non surgical options for nasal problems like acne scars, where collagen or dermal fillers some like as a treatment option. I did not like the permanency issues to offer that for my own patients.

One important issue for evaluating a non surgical option, can that doctor offer surgery?  Do they have hospital privileges in that operation?  What Board Certifications do they have? Here is something I used to check doctors I was seeing complications from the American Board of Medical Specialists:

http://www.certificationmatters.org/is-your-doctor-board-certified.aspx

I did offer non surgical options such as Non Surgical Body Shaping Garments which were an immense asset for my patients who were trying to stabilize their problem or wait until they could afford surgery, or the right time of year. The difference, is that option had careful documentation of before after pictures and I could offer surgery and demonstrated the options each way with critical documentation. 

But back to a "Nose Job."  When I was still in practice evaluating unhappy patients after surgery done elsewhere, the starting point is

What was the original problem?
What sort of trauma happened before? Some Nasal Fractures can leave parts of the nose stronger with the healing process, other problems can weaken, just depending also on many factors.
What was done?
What was the individual unhappy about?
What was my exam of the tissues like?



Some of the unhappy patients I saw had silicone nasal injections, silicone implants, other implants like gortex, acellular matrices of various types, cadaver dermis, and a whole slew of different substances.

The basic problem I saw that was not well documented by most proponents was the airway. To push out, any material put between the skin and the cartilage must push back in. This is usually not a factor when referring to the dorsum and support by the underlying septum framework. However, I saw complications when even that support was buckled when trying to convert a flat nose into a projecting one like an Oriental to Caucasian modification. But for the critical internal valve of the nose, it takes so little to destroy the airway. The tip support is somewhere between. I have seen even surgical attempts at projection disrupt the support system. Careful before and after pictures and measurements were the best I was able to come up with before my practice evolved away from Rhinoplasty sculpture.

Now what happens if a supporting system is weakened from some injury, event, surgery, or what ever?  Too many factors to be able to prove one way or another. We all get swelling from trauma. That distorts the nose. But minimizing the amount of the swelling and length of time probably lowers the probability if the effect being permanent. What about longer effects of a material that is mostly gone after x months? Again, who is able to document the changes?  How critically are they showing proof that the nose returns to the prior state? Again, I did not see enough proof to offer it.

I did offer structural changes using cartilage grafts and suture to get living tissue to continue the shape. I did like what I saw others showing me to offer that type of Rhinoplasty. But for permanency, my patients were cautioned about the fickle nature of the nose and its cartilage framework. Use this site's search engine and you will see that phrase all over the Encyclopedia and forums. That is the nature of the material.

For my patients I preferred using my computer drawings during my Rhinoplasty Consultations to discuss the range of what surgery might offer. But the beauty of about the thinking mind, is that whatever I was doing, I was looking for something better. I have yet to see a "non surgical nose job" that I was willing to offer. But time are a changing and perhaps something will become available. I like the idea of structural shape Reconstructive Ear Otoplasty Forum - Building Ears With 3D Printing Progress. Something that can tie into real current support or provide new support on its own But these are structural frameworks that are hopefully going to be built out of our own body's cartilage, a living support system, that my guess will be a surgical sculpture.

Back to your problem. Why not post before pictures and after pictures?

Here is another post about Rhinoplasty Standard Views:

Rhinoplasty Forum - Standard Pictures For Nose and Nasal Deformity

Hope this helps,

Michael Bermant, MD
Learn More About Rhinoplasty, Septoplasty, and Sculpture

[maria]

It‘s v helpful and informative indeed! Thank you v much. We consumers need to get more educated about the risk factors involved before going under the “Non Invasive” needle. It’s immensely disappointing and frustrating when the claim and promise of a safe experience proves otherwise and also when the proclaimed non permanent results effected leave undesirable change to the original form with new set of problems. A serious disadvantage is lack of information and resources covering such issues that could be accessed over the web. As you have mentioned, critical documentation and research on the matter should be made available to the public for them to make truly informed decisions rather than learning about them from unfortunate experiences. A sincere thanks again. Would post pics soon to get some more understanding on the problem.

[maria]

 looking up the anatomy of nose, I learnt that, aside from the nasal spine, the upper and lower lateral cartilages are also dependent for support on the soft tissue envelope. Does this factor make them more prone to displacement in response to interaction with the overlying envelope and the subsequent swelling,  the material push in and later shrinking back when  material goes away?

[DrBermant]

It‘s v helpful and informative indeed! Thank you v much. We consumers need to get more educated about the risk factors involved before going under the “Non Invasive” needle. It’s immensely disappointing and frustrating when the claim and promise of a safe experience proves otherwise and also when the proclaimed non permanent results effected leave undesirable change to the original form with new set of problems. A serious disadvantage is lack of information and resources covering such issues that could be accessed over the web. As you have mentioned, critical documentation and research on the matter should be made available to the public for them to make truly informed decisions rather than learning about them from unfortunate experiences. A sincere thanks again. Would post pics soon to get some more understanding on the problem.

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

The Plastic Surgery Societies I belonged to were concerned about how members presented themselves and what they offered that there were specific rules incorporated into a Code of Ethics. Results shown in the office, in advertising, or on the web, are all defined to protect the public.

Not all societies are the same nor have the same rules. That is why checking just what International Plastic Surgery Society Resources the doctor belongs is a start. But then nobody is making a list of the societies that have looser requirements for membership or what types of ethics codes are part of that membership. I find it fascinating that is not addressed and is left up to the public to wade through on their own. But then again, who is policing the society members? Reporting them is another matter. The surgeon should have the right to face the accuser, this should not be a hearsay process.

For my practice, my policy was to set up a critical methodology to document the problem, the healing, and results. This was not just a part of a more complete documentation, but also as a leaning tool for myself to make me a better surgeon. I then learned of the power of the Internet over 16 years ago to show this documentation: the problems, results, and the paths taken. My patients were telling me that they had studied my pages, sometimes for years, before coming to see me. This online documentation then became part of the patient education process. I learned that my patients could do a better job helping with the recovery when they know what to expect or if their results were not on the typical path for my techniques.

I am retired now, but the methodology still holds. Those with problems can use these standard views for documentation. This can be the case for someone unhappy with their nose, or someone else trying to lose weight or build their muscles, or skin care program. I am hoping the process continues and better methods evolve beyond what I was doing. I seriously doubt that I have done the "perfect" operation, that others will learn to do it even better. But who knows, what the future will bring.

You are welcome to post your images, but they should be at least using the Standard Rhinoplasty Pictures which I just updated to show the issues involved with lens distortion. I still need to take more time on the entire rhinoplasty section. But that is for another day.

Hope this helps,

Michael Bermant, MD
Learn More About Rhinoplasty, Septoplasty, and Sculpture