History of Non-surgical Rhinoplasty
Non-surgical rhinoplasty is reported to have originated at the turn of the nineteenth century, when New York City neurologist James Leonard Corning (1855–1923) and Viennese physician Robert Gersuny (1844–1924) began using liquid paraffin wax to elevate the “collapsed nasal dorsum” that characterizes the “saddle nose deformity.” Yet, despite its corrective efficacy, liquid paraffin proved biologically harmful.
During the 1960s, soft-tissue fillers of medical-grade silicone gel were introduced to the rhinoplastic surgeons. However, like liquid paraffin, silicone gels proved biologically harmful, causing ulcers and granulomas, as reported in 1977. To minimize the risk, in 2000 D.S. Orentreich advocated the “microdroplet technique”, minute doses of silicone injected over multiple sessions.
In 1977, Robert Kotler, MD, FACS, learned the microdroplet technique from Jack Startz, M.D. and began offering a permanent nose job to his patients. Appointments were separated by five to six weeks; the procedure cost less than a surgical rhinoplasty.
In 2002, American otolaryngologist Dr. Alexander Rivkin began using injectable fillers like Restylane and Radiesse that had recently been approved by the FDA to improve the contours of his patients’ noses. He developed an office based procedure consisting of a series of small filler injections in precise locations on the nose. After performing the procedure regularly in 2003, Rivkin publicized the method in a variety of mainstream American news outlets as the “non-surgical nose job” and “injection rhinoplasty.” The main goal of the procedure was to make a bumpy or curved nose appear straighter. He observed that straightening the nose made it appear smaller (even though he was augmenting) by making it blend better with the contours of the rest of the face. This observation was echoed by later physicians as well. Rivkin’s 2009 study of 385 patients remains the largest published experience with this technique in the world.
In 2005, the Australian Dr. Andrew Tuan-Anh Le published a pilot study reporting successful corrective outcomes using the soft-tissue filler polyacrylamide gel (PAAG), a hydrophilic colloid injected to the tissues of the nasal defect, and known commercially as Aquamid.Other soft-tissue fillers have since come into use as well, and the injection procedures have gained popularity due to their non-invasiveness and low cost.