A nonsurgical rhinoplasty is an injection technique where filler material is injected into areas of the nose to create the illusion of a rhinoplasty procedure.  A patient who has a nasal hump can be injected above the hump where there is a relative depression compared to the prominence of the hump and this can then give the illusion that the hump is smaller.  If there are any depressions or irregularities to the nose, these can also be filled with filler material.  The far majority of individuals that perform nonsurgical rhinoplasties are individuals that do not have the ability to perform a proper rhinoplasty in the first place.  I blog on nonsurgical rhinoplasty only to, for the most part, condemn it as I do not feel this is a proper technique for treatment of the nose except in extenuating circumstances such as a patient that has contraindications to a surgical procedure or in a patient that has a prominent depression or irregularity and is only seeking a temporary solution to the problem until they can have a formal rhinoplasty performed.  Otherwise I feel that the nonsurgical rhinoplasty especially if performed with longer lasting or permanent fillers is fraught with complications that are extremely difficult to rectify.  I have personally performed nonsurgical rhinoplasties, but only in the circumstances previously mentioned.  I would therefore recommend that anybody that desires a nonsurgical rhinoplasty seek a very experienced rhinoplasty surgeon, so that all of your options can be discussed.  If you seek out a person who advertises nonsurgical rhinoplasty, more than likely you will be seeing someone who is not experienced in the actual rhinoplasty surgery and your options will therefore be very limited.  I describe this to my patients as the saying of “when your only tool is a hammer, all the world is a nail”, which means that if you do not know how to do a rhinoplasty, you will never offer this surgery to your patients.  I once again therefore highly recommend you seek out an experienced rhinoplasty surgeon so that you can have all of your options explained to you in detail.

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Yes, it is possible to perform a tip rhinoplasty on a nose with very thin skin, but it is very important that the surgeon take into consideration the thinness of the skin when planning the techniques for the procedure.  The reason behind this is that certain techniques can be performed on the cartilage of the nasal tip that will help thin a nose with very thick skin and these techniques would never be performed on somebody with thin skin as it would create an overly thin or pointy tip.  One has to be very careful doing a rhinoplasty on very thin skin as every nuance of the underlying cartilaginous framework will be visible through this very thin skin.  Now, this can be a significant advantage in certain circumstances when we want to create a rather sculpted tip.  A sculpted tip can be achieved in a patient with very thin skin and this really can never be achieved in somebody with very thick skin.  I would therefore recommend that you see an extremely experienced rhinoplasty surgeon and discuss the options for tip rhinoplasty and make sure that these options take into account the thinness of your skin.  Certain techniques such as shield grafts, cap grafts, cephalic trim, and dome suturing are all techniques that would be used in a patient with very thin skin.  These techniques would have to be executed extraordinarily precisely so that the nasal tip has a very nice natural and harmonious appearance, but when these techniques are employed in a very meticulous fashion, the results can be outstanding and will obviously last a lifetime.

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The likelihood of having a worse nose after rhinoplasty is exceptionally low.  I have personally performed over 750 rhinoplasties and have never caused the nose to look worse after the procedure.  With that said, there are instances where the nose does not look the way that we intended and certainly a small amount of patients end up requiring some sort of a revision surgery to the nose after a rhinoplasty, but in my hands, this percentage typically is less than 5% or about 1 out of every 20 rhinoplasties, so the chances of having a nose that looks worse after surgery is essentially zero, but the change of requiring some sort of a revision rhinoplasty nationally speaking is probably in the 10 to even up to 15% range, but in my personal hands averages around 5%.

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Yes, eyelid surgery can indeed improve or correct a protruding lacrimal gland.  A protruding lacrimal gland will be visible as a bulge to the outside of the upper eyelid.  This is typically found in older patients and can be corrected by tucking the gland back up under the bony socket and then securing with a mattress style suturing technique.  Occasionally the fibrous layer can simply be tightened by gentle cauterization with the bipolar cautery and this is not uncommon for me to perform during upper lid eyelid surgery on any age group.  The overall goal of an upper eyelid blepharoplasty is to create a nice symmetric upper eyelid crease so a few millimeters of the upper eyelid is visible above the eyelashes across the entire length of the upper eyelid.  This gives a nice rejuvenated appearance to the upper eyelid without creating a hollow or operated look to the eye, which is undesirable.

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The answer to that question depends on what type of a facelift procedure is performed.  If it is a minilift-style facelift similar to a Life Style lift or Quick Lift, most patients have minimal bruising and will have less than a week of what they consider downtime.  That is assuming that they can cover up the area where the sutures were placed with their hairstyle as these sutures will be in place for six days.  If they have a more sophisticated facelift such as an extended SMAS deep plane facelift with platysmaplasty, I do leave a small drain in the area to evacuate any excess fluid overnight and this is removed the following day.  I feel this reduces the amount of visible bruising that they get and most of my patients still only have approximately one week of any significant downtime and on day six or seven those sutures are removed and the majority of patients can wear a small amount of cover makeup to camouflage any residual visible bruising and they would be able to resume relatively normal activities.   Some patients especially older patients will have an additional week of downtime just due to some residual swelling in the area, but overall most patients only have approximately one week of downtime from a facelift.

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