Artefill is a filler that is effectively permanent due to the fact that the body cannot degrade it. It is composed of tiny microspheres in a suspension of bovine collagen. The collagen gets degraded over time but the microspheres remain and induce an inflammatory response by the body which deposits new collagen around it.

Because the results of Artefill depend on each individual's response to it, there is a certain amount of unpredictability. It is therefore prudent to initially under correct with artefill and use it in stages until the desired outcome is achieved.

Like most of the other fillers, Artefill is only FDA approved for injection into the nasolabial folds. Like all the other fillers, practitioners can use it in off label ways and inject it anywhere else they deem to be safe. That is where different doctors might have varying viewpoints as to where it is safe to inject.

The only places I would inject Artefill are in the nasolabial folds, bridge of the nose, high cheek bone area, and prejawl sulcus. All these places are conducive to deep injections on or close to the bone. The deeper the material is injected the less likely it is to cause troublesome lumps or other issues.

Because Artefill contains bovine collagen, a skin test is needed about a month prior to administration of Artefill to make sure you do not have an allergy to it. This is done for free in our office.

By Dr. Gal Aharonov

Non surgical rhinoplasty usually entails using either fillers such as juvederm, restylane, perlane, or radiesse to help change the shape of the nose. Botox or Dysport can also sometimes be used to help change the way certain muscles affect the nose.

It is not possible to absolutely reduce the size of the tip of the nose or nose in general using non surgical nose job, but it is possible to make the tip seem smaller, or make a hump or bump on the nose seem smaller. This can be done by affecting the relationships of the nose. For example, for someone with a scooped out nose who seems to have a large tip, building the bridge of the nose can make the tip seem smaller. Conversely, in a person with a small droopy tip that seems to have a big hump, building the tip support a bit can make the nose seem more balanced and less droopy.

It is also possible to hide a bump on the nose by building the surrounding structure with filler in a non surgical nose job.

Feel free to read more about non surgical rhinoplasty or non surgical nose job.

Yes. During your rhinoplasty surgery we will take pictures of your during your rhinoplasty consultation. We will be able to look at your pictures on the computer and morph them using a special computer program to show you what your nose can look like after your rhinoplasty surgery. It is a good communication tool for both you and me to decide what nose is best suited for your face. Sometimes we think a little nose is best for our face but seeing it on the computer might make you think that it would be too small, or too large, for your face.

I spend on average about an hour with each patient taking the time to decide what is best for you. We can also go over some previous patients who have had rhinoplasty surgery and how their nose looked after surgery compared to the nose we decided on with the computer morphing program.

Morphing software for rhinoplasty surgery is an important part of the consultation that helps us decide what is best for your particular needs.

Rhinoplasty surgery has to be performed with special attention to your breathing apparatus. If the rhinoplasty surgery is done without supporting your nose properly, your breathing can become progressively worse over years as scar contracture continues to pinch your nose over time. Going to a facial plastic surgeon, who has extensive experience in the functional workings of your nose, will make it less likely that you will have breathing issues after your nose surgery.

Special techniques can be used during your primary rhinoplasty surgery to make sure your nose remains strong and will not collapse afterward. If you have problems breathing from your nose after rhinoplasty surgery not all is lost. It is possible to rebuilt and support the collapsed and pinched nasal cartilages through a revision rhinoplasty surgery. Cartilage can be taken from your septum to help rebuild the nasal cartilages so you can breath better through your nose.

Non Surgical Rhinoplasty or Non Surgical Nose Job usually entails using a filler such as radiesse or juvederm or perlane to augment or change the shape of your nose. In the bridge, the filler tends to last a fair amount of time. I err on conservative estimates and tell patients it will need to be redone every 6 months or so, but I have had many patients for whom it has lasted for over a year.

Initially, there is some swelling associated with the injection, especially if it is your first time. You might need a small touch up once the swelling subsides about 14 days after the first injection.

You can read more about non surgical rhinoplasty by visiting our non surgical rhinoplasty page

It is possible to make your nose a bit bigger. It might even be possible to do without surgery, just with a bit of filler. This is called a non surgical rhinoplasty. If you prefer a more permanent solution, a revision rhinoplasty can be performed to make your nose bigger. Some of your own cartilage can be used, either from your septum, the inner bowl of your ear, or rib cartilage, or synthetic material such as gortex or an irradiated rib graft. Whatever the material to be used is, the concept is the same: give your nose a larger stronger structure.

There are pros and cons with either the non surgical rhinoplasty or the revision rhinoplasty. With the non surgical rhinoplasty the advantage is that it is quick and virtually pain free and you see the results right away with almost no downtime at all. You can actually go back to work or go out the same night as having the non surgical rhinoplasty procedure done. The downside is that it is not permanent and you will need touch up procedures to maintain the results anywhere between 6 months to one and a half years.

you can visit the non surgical rhinoplasty page

The advantage of having a rhinoplasty revision or redo nose job is that it is permanent and you will hopefully never have to deal with it again. The downside is that it is surgery, causes a fair amount of swelling and downtime of about 1-2 weeks.

You can visit the revision rhinoplasty page

There are a few circumstances where injectable fillers can be used in the nose. This includes building up the bridge of the nose, smoothing out an irregularity in the nose, or increasing the projection of the tip.

In people with a low bridge, either naturally or due to over aggressive surgical reduction, fillers can be used to build up the bridge again. This is a good option for people who do not want to undergo another surgery, and who don't mind coming in every 9-12 months for touch ups.

In people with an irregularity, again either naturally occurring, due to trauma, or due to surgery, fillers can be used to smooth out and camouflage these irregularities.

It is also possible to get some tip projection using fillers as well.

As for the type of filler to use, I like to use either restylane, or juvederm as the initial injection. This is because these fillers can be dissolved in the event that you don't like the results of the injection. Hopefully this will not happen, but it is nice to have the built in safety of knowing the filler can be dissolved. In patients who have been happy with an injectable filler in the nose in the past, radiesse can be used to give a longer lasting correction.

I will go over all of your options with you during the consultation, which will include both surgical and non surgical options to address your issues. There are pros and cons to all interventions and we will go over all of them.

The vast majority of rhinoplasties can be done closed. That means there is no incision that is made across the skin between your nostrils. This is especially true if you have never had a rhinoplasty before. For revisional rhinoplasty, sometimes it is helpful to perform an open rhinoplasty because it aids in visualization and can make the procedure much easier. For primary rhinoplasty--that is, for people who have never had a rhinoplasty before-- 99% of the time there is no need to open the nose and it can be done closed--the incisions are all inside the nose.

The incision for an open rhinoplasty tends to heal very well and can be very hard to even find once healed. Some surgeons prefer performing open rhinoplasty and some surgeons prefer doing only closed. I can do either, but if I can perform all i need to perform closed then there is no reason to open the nose. I wil never compromise the final results though, so if it is impossible to do closed then I will open the nose. That is very rare though.

Ending up with a nose that is too small and that doesn't function well is a very common problem in rhinoplasty surgery. Too much bone and/or cartilage was resected, leaving the nose fragile and weak leading to breathing difficulties.

The good news is that your nose can be rebuilt and made stronger and bigger. Cartilage grafts can be taken from your septum (if enough was left after your first surgery) and used to help rebuild your nose. If enough septal cartilage is not available, cartilage can also be taken from the inner bowl or your ears (dont worry, your ears stay the same shape). Beyond that, rib cartilage can also be used, as well as synthetic material.

If you are having difficulty breathing, your insurance might actually help pay for your surgery to fix your breathing problems.

Your nose can be made to look normal and function well.

Revision Rhinoplasty is a highly personalized procedure addressing the specific needs of each patient depending on their issues. At times, all that is needed to be done is just a small touch up procedures. Other times, the revisional surgery seems more like a reconstructive case needing to rebuild the nose practically from scratch. I always try my best to do the least invasive procedure that I can. That means that if it is possible to do a closed rhinoplasty I will do all I can to not open the nose. But at times it is virtually impossible to do a good job without opening the nose. The resultant scar of the open rhinoplasty heals VERY well when done properly. It is therefore not worth sacrificing a better result for a small factor. But again, if it is possible to get the same results without opening the nose then why open it? I would say that about 70% of rhinoplasties can be done closed.