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1st Apr, 2018

At Revere we constantly meet people who hate their noses and have done all their adult lives. The idea of surgery to improve the look of their noses terrifies them and more often than not they decide to carry on and try to and live with a nose they loathe.
I grew up watching Indian cinema, with its larger than life characters and melodrama. Along the way, somehow I learnt the language, fitting the English subtitles against what I could hear being said and expressed on screen. One line you were guaranteed to read in almost every movie was, “”you’ve cut my nose off””, something that always confused me as there was never any associated violence, blood or sharp instruments, just lots of crying!

It was a few years later when I got to medical school that the penny dropped. The nose, in the ancient Indian subcontinent signified “”reputation”” and in certain communities it was a common punishment to amputate the nose, (also known as rhinokopia) to strip a man of his honour. This created the first cosmetic market for nasal reconstruction and the first pioneer of rhinoplasty was Shushruta in around 500 BC.

Over the years, surgical rhinoplasty has evolved, and although the Shushrata approach is still used, modern-day techniques can, with the right expertise, provide excellent results with minimal complications and quick recovery times. Surgical rhinoplasty is consistently in the top five surgical cosmetic treatments performed in the US, with almost 140,000 procedures done in 2009 alone.
Over the past five years, there has, however, been an unprecedented rise in the non-surgical nose job using dermal fillers, such as Juvéderm Ultra. We’re now able to offer a reshaping procedure with virtually no downtime, immediate results and without the risks associated with surgery and general anaesthesia. The procedure is has been widely adopted by surgeons and non-surgical practitioners alike.

After consultation, photographs are taken and images are annotated detailing the likely outcomes. An anesthetic cream is then applied for approximately 30 minutes. The skin, once disinfected is injected with the filler gel with a series of anything between two and eight injections and the procedure shouldn’t take more than 10 minutes. Aftercare involves a gentle pinch of the sides of the nose twice a day for a couple of days to minimise any migration of the product and to allow the product to integrate into the skin. Clients are also advised to avoid any excessive heat sources, not to wear sunglasses or sleep on their faces for a few days.

The procedure is ideal for those who are looking for a subtle change to correct mild irregularities of their profile, softening bony or cartilaginous prominences, to bulk out small areas and address traumatic scars and asymmetry. Despite the indications being quite comprehensive, Revere do actually turn away more clients than we treat as the procedure does not de-bulk or thin the nose, sharpen soft features or correct septal deviations and structural issues that cause breathing difficulties.
The most common question I get asked is if the nose looks bigger after the procedure. Paradoxically, I find that although the nose actually has gained volume, the improved profile and removal of the irregularities actually cause the nose to draw less attention, thereby appearing smaller.

The filler needs to be topped up at least once a year and costs around £350. The chance of adverse events such as bruising and infection are less than 5%. In patients that have had previous surgical work, I would advise against semi-permanent fillers in the first instance due to the risk of skin necrosis where the filler material compromises the blood supply to the skin. Sticking to something such as Juvéderm Ultra is best as it’s easily dissolved.

Keep your noses out of trouble!

Dr. Sach

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