The Tragedy of the Instant Noselift

CEBU, Philippines - Cosmetic surgery of the nose is the most common operation done by plastic surgeons here in the Philippines. In fact it is a procedure that is considered as the bread and butter for some. The demand for noselift surgery has tremendously increased in the last 20 years but the number of properly trained plastic surgeons has not increased accordingly. This situation has led to the proliferation of fake plastic surgeons (they like to be called cosmetic surgeons); doctors of other specialties trained to be experts in their respective fields but were enticed to perform plastic surgery; and lastly unscrupulous people who are not even physicians but are daring enough to offer the public the “instant noselift.” It is not surprising then that complications from noselift procedures is the most common problem faced by plastic surgeons today.

What is an“Instant Noselift?

An instant noselift is a procedure that increases the height of the nose by injecting something underneath the skin of the bridge of the nose. The material is usually a foreign body, silicone liquid, molten wax, “synthetic fat” or practically anything that can pass thru the needle. Since there is no surgery needed there is no healing time required, thus the term “instant.” The amount of material injected into the nose determines the degree of augmentation making it a very easy procedure to perform. The cost is usually cheaper than when surgery is done, making this option very attractive to patients who have a limited budget and at the same time are scared of surgery.

What are the disadvantages of noselifting by injection?

When medical grade silicon liquid was made available for injection in the 70s, it was mainly used as a filler material to efface or improve the fine wrinkles of the face, especially around the eyes. A few enterprising individuals started to inject this material into the nasal bridge producing an instant lift. After a period of time, surgeons noticed that the liquid silicon would migrate downwards on the more dependent portions of the face, causing hideous deformities. Because of this, the USFDA banned the use of silicon liquid for injections and was withdrawn from the market. When silicon for injection was no longer available, quack doctors resorted to different types of substitute materials they can inject into tissues. All of these materials produced what we call “foreign body reaction” when inside tissues. This results in the production of hard, deforming scar tissue, which is difficult to remove without injuring the adjacent normal skin. The skin of the nose, underlying tissues and the mucosal lining of the nostrils become thick and hard not only producing an ugly deformity, but often times making breathing difficult.

When molten candle wax was used, patients found out that the resulting improvement

was temporary since the wax softened and got deformed when exposed to the heat of the sun. When prospective patients learned about this from friends, they erroneously expect the same complication with surgical rhinoplasty. They often ask us if they can stay under the sun for long periods of time.

A more serious issue is the safety of the materials used for injections. The injected nose might look good and normal for the first 3 or 5 years but what happens in the next 20 or 30 years is unknown.

The Big Problem

What bothers plastic surgeons is that the deformity produced by injections in the nose is not only very difficult to correct but often times impossible to remedy. One of the most depressing experience in the clinics is when a distraught patient seeks help for these problems and the only thing we can offer is to tell them that they have to learn how to live with the deformity. If an inexperienced surgeon attempts to remove the foreign body aggressively or incorrectly, the blood supply of the nose might be compromised, resulting in a worse looking nose. This would be an example of “the cure is worse than the disease!”

If surgery correction were still possible, usually the treatment would involve several operations before an acceptable outcome is achieved. Patients who opt for Injection Rhinoplasty in order to save money end up spending much much more than when they could have the right surgery with the right surgeon.

What to do to avoid this dilemma?

Time and time again, I have emphasized the importance of choosing the right doctor to do the job. Rhinoplasty or noselift is still a surgical procedure and should be done by a well-trained surgeon. Well trained in the sense that they can’t only do the surgery well but could take care of all complications, as well.

Avoid making decisions for the procedure based only on a friend’s wonderful experience. Most complications manifest several months and even years after the procedure is done.

If unfortunately you already had the injections, then observe your nose and have regular follow up visits to your plastic surgeon and follow his advice.