Noses occupy a prominent position on the human face. Many normal anatomic and ethnic variations exist and, depending upon proportionality (e.g. width, length, projection, etc.), the rest of the face can accentuate nasal variations. In some individuals, these variations can and do detract from the overall aesthetics of the face. The key to any surgical or non-surgical intervention by a plastic surgeon is a carefully performed detailed facial analysis. Once analyzed, a surgical or non-surgical approach involving the nose and interplay of the middle and lower third of the human face both in terms of bony structure and soft tissues such as fat pads, muscle of the lips and mouth and chin can greatly enhance the appearance of the nose.
A common nasal variation that many Middle Eastern and Asian descendants have, which they commonly want corrected, is a prominent nasal dorsal hump which slides down an inclined plain to a projecting nasal tip referred as the “poly beak” deformity. Often this is paired with a prominent caudal (lower) septum that plunges downward giving the appearance of a large view of the side nostril. The nasal tip can be further pushed downward during smiling animation if the person has a paired muscle that spans the lower portion of the nose and inserts into the circular muscle of the lips/mouth. Any time the person animates a smile it further pulls the lip upward and the tip of the nose downward. If the lower facial third is diminutive with respect to the middle facial third, such as people with an underbite, the nose in these cases rises to a more prominent position with the overall face. Without question a definitive surgical open septo-rhinoplasty for nasal deformities would provide the best results and, if the individual has the above-mentioned dental-skeletal relationship, adding a chin procedure such as a genioplasty or, if indicated, a chin implant would add harmony with the lower facial third to provide a superior result.
Alternatively, if surgery is not an option, non-surgical approaches can be employed to reduce the appearance of the anatomic variations that might displease the individual. Once again taking a very global detailed facial analysis is imperative to achieving the best results. Primiarily, if a patient presents with the animation deformity of the nasal tip when smiling leading to further lack of nasal tip projection, planned neurotoxin injections such as BOTOX or Dysport can be placed into the depressor muscle under the lip to prevent this action from occurring. If the patient has a retruded chin as we have specified previously, we can enhance the projection with a filler agent such as Radiesse which has the greatest “G prime” number meaning it resists deformity better than any other filler agent. Radiesse can be injected just above the bone on the chin’s tissue to enhance the furthest projection point of the chin creating a more balanced lower facial third making the nose appear less prominent. With respect to the nose itself we can add a hyaluronic acid filler agent such as Juvederm Voluma to the dorsum of the nose to soften the appearance of the nasal hump in conjunction with additional volume added to the nasal tip minimizing the “hook nose” shape. If the plunging caudal (lower) septum gives a greater view of the inside of the nose from a lateral view then adding a filler agent in the nasal mucosa above the lower lateral cartilage may act like a alar strut graft and push the inferior alar rim downward to reduce visualization of the inside of the nose.
If patients have had previous trauma to the dorsum of the nose or have an anatomic variant such as a ski slope deformity, added volume deep to the dorsum and below the skin can build this area up obscuring the underlying deformity. One important point to make is that non-surgical approaches cannot provide a subtraction affect which is needed in a bulbous nasal tip but can provide added volume in other areas such as the chin to balance out the enlargement of a nose.
Bottom line: never chose a provider to perform non-surgical approaches to the nose if they are not already an experienced rhinoplastic surgeon because filler agents are not in-expensive and it takes years of experience to be able to properly analyze and treat noses for optimal results, therefore – invest wisely.