No rhinoplasty patient wants to end up with an overdone or unnatural nose. Unfortunately, poor-quality cosmetic surgery is not uncommon. 

Look around, and you’ll likely see too-scooped, too-short, or nostril-flaring nose jobs.

The possibility of unnatural post-op nose appearances may be why some patients, justifiably wary of a trip to the operating room, prefer non-surgical options.

As the number of people needing a nose enhancement or “touch up” rises, Dr. Robert Kotler, a Beverly Hills rhinoplasty superspecialist, offers a highly specialized procedure known as permanent non-surgical rhinoplasty.

He has developed the Kotler Saline Demo, a clever and practical way to give you a sneak preview of the result of permanent filling.

Whether you are a first-time nose job patient or want a rhinoplasty redo, Dr. Kotler’s individualized, non-surgical approach to rhinoplasty can help improve your confidence and facial appearance. 

About the Permanent Filler

The only filler recognized as permanent is medical-grade liquid silicone. 

With over 70 years of success, silicone has become an essential element in medical care. Pacemakers, artificial blood vessels, artificial joints, and every “tube” placed into patients is made of silicone. 

Well tolerated by the body, this synthetic compound is one of the great achievements of modern bio-science.

The most common silicone product is marketed as Silikon 1000.

What Is Silikon 1000?

Silikon 1000 (S1000) is a trade name for clear, colorless, medical-grade liquid silicone. The product is manufactured for use as a permanent filler in appropriate areas. 

FDA-approved Silikon 1000 has been successfully used for acne scars and lasts longer than any collagen injectable. It has over a 60-year track record of success. 

The FDA (Food and Drug Administration) originally approved the use of Silikon 1000 (purified polydimethylsiloxane) to “push back” a detached retina. 

However, doctors have used Silikon 1000 off-label as a safe, effective, and durable filler that can provide permanent results.

Generally, there are very few issues with the product when properly used. Being conservative is essential to improve outcomes and prevent complications.

What Can Non-surgical Rhinoplasty With Fillers Do?

The non-surgical approach to rhinoplasty is a thought process by which the cosmetic surgeon first considers whether or not to correct an imperfect nose without surgery. 

Non-surgical procedures use temporary dermal fillers, including hyaluronic acid, Restylane®, Voluma, Radiesse®, and Juvéderm®. Permanent non-surgical liquid rhinoplasty uses Silikon 1000. 

If it is likely that the ideal cosmetic procedure is non-surgical and can render the nose quite satisfactory, then non-surgical liquid rhinoplasty should be considered the first choice. 

A plastic surgeon must consider this method and other rhinoplasty options when recommending to the patient. 

Patients prefer to have all possibilities explained to them during consultation.

The Use of Silikon 1000 as a Cosmetic Treatment

The primary use of silicone is to plump, fill, and lift depressions. That is why silicone has some benefits for acne scarring and has been used in the nose.

Silicone is the ideal nose filler since the nose is a non-moving part. Therefore, no force is exerted against the product when placed underneath the skin adjacent to the underlying framework of bone and cartilage.

The microdroplet technique is the preferred technique when using silicone filler.

How Does Silikon 1000 Work?

Silikon 1000 is an off-label use. However, it is perfectly legitimate. It is used as a filler and is deposited underneath the skin for imperfect noses. 

Silikon 1000 is permanent and contrasts with collagen and other injectable materials, which do not have a lifetime benefit. All of those substances dissolve over time.  

After depositing Silikon 1000 using the microdroplet technique, nature will form a capsule or a wall around the silicone oil, rendering it immobile and not subject to movement. 

This mechanism is the key and the reason why it is permanent. 

The nose is a perfect harbor for the product since there is no significant muscular activity to exert an adverse effect upon the formation of this capsular wall. 

Injections into the lips, eyelids, or other moving parts place considerable uncertainty into the outcome and the possibility of disability.

Restoring Balance

The nose is the most defining and prominent feature of the face. When ideally shaped, the nose helps to bring your facial features together and create a balanced profile.

Cosmetic imperfections – such as dorsal bumps, a drooping nasal tip, or a crooked nose – can disrupt the aesthetic balance of your features.

What Is a Non-surgical Nose Job?

Non-surgical rhinoplasty is the correction of nasal imperfections without surgery downtime or side effects. It is an office treatment using medications that can either fill dips, divots, depressions, or asymmetries.

“Shrinkers” are also available, which can often shrink some swollen tissue and positively accentuate the somewhat hidden architecture.

What Can Permanent Non-surgical Rhinoplasty Improve?

This quick procedure is an excellent option for treating minor cosmetic nasal flaws. Non-surgical rhinoplasty cannot make the nose smaller or alter its internal structures.

Permanent non-surgical rhinoplasty is frequently chosen by patients who want to:

  • Conceal dips, divots, and depressions on the outside of the nose
  • Disguise nasal bumps or humps
  • Correct appearance of a crooked or asymmetrical nose
  • Revise initial rhinoplasty and correct post-op defects
  • Refine or subtly lift the nasal tip
  • Augment and elevate nasal bridge
  • Smooth away cosmetic imperfections from a broken nose
  • Balance asymmetrical nostrils

For patients who need significant structural changes, such as improving breathing and preventing recurring sinus infections and allergy problems to the nose, surgical rhinoplasty is a more appropriate choice. 

At your initial consultation, Dr. Robert Kotler will help you thoroughly explore your options and discover which procedure best meets your expectations and preferences.

What Are the Benefits of Silikon 1000?

Here are some of the benefits of using Silikon 1000:

  1. It is permanent.
  2. It is predictable.
  3. Sequential sessions serve the patient best by allowing nature to perform ideally with its encapsulation process, and giving the patient a six-week interval between sessions to evaluate their desires is very significant.
  4. Silikon 1000 does not require a lifetime commitment compared to collagen-based injectables, which must be renewed forever if one wishes to engage in that program.

Is Silikon 1000 Safe for the Nose? What Are the Risks of Silikon 1000? 

Side effects are extraordinarily rare. Silicone does not engender infections. Typically, there are very few reactions, although some people get a little bit of redness, which is attributable more to the injection than the deposit of the Silikon 1000 filler itself.

There is little risk of complications, given the tiny needle used and the small amount of filler deposited under the skin. 

The risks are more related to the administration. The surgeon must be comfortable with the nose anatomy and ensure he is positioned away from the major blood vessels. 

The anatomy is consistent, so confident practitioners “know their way around.” Using a very fine needle and drawing back on the plunger before injecting gives assurance that the needle tip has not entered a vein or artery. 

That is the safety measure that translates to less chance of any complications. Infections are virtually unheard of. There is minimal reaction to the product.

Are You a Good Candidate for Silikon 1000?

Silikon 1000 would be appropriate if you suffer from nose asymmetries, depressions, or jagged cartilage edges under the skin. It is also suitable for a low bridge due to one’s ancestry. 

Typically, Asian patients would like to see the bridge raised. Another use is to refine the tip so it looks less bulbous when placed in the central portion of the nose tip, creating an illusion of a more pyramidal and less boxy tip.

The significant improvement rendered is a reasonable alternative to one or more surgical procedures for many people. It is not interchangeable with cosmetic surgery. 

Often, surgery and filler may be necessary to accomplish the ideal goal. These procedures are done at different times. 

What Is the Cost of Silikon 1000?

Silikon 1000 fees differ from those of the absorbable injectables, which are typically priced by volume. 

In the world of Silikon 1000, it is impractical that the fees be based on volume since multiple microdroplets and several sessions are involved. Different patients also require varied volumes and a variety of office visits.  

The most practical way is having a “fixed price” that encompasses the basic number of injections. The fee includes the surgeon’s time and talent and the medical-grade silicone oil itself.

The Kotler Saline Demo

This “test drive” or preview is a practical and quick way for the patient to see, mirror in hand, the result of the permanent non-surgical revision rhinoplasty. 

The saline, sterile salt water, injected under the skin, under a topical skin anesthetic, will demonstrate to the patient the result of the permanent filler. The likelihood of success is very high if the patient likes what they see. 

Photos are taken before and after so the patient may examine the result in the quiet and comfort of home. There is no better way to appreciate what can be done without another surgical rhinoplasty.

How to Determine If a Permanent Non-surgical Nose Job Sounds Too Good to Be True

The other permanent nose job is a permanent non-surgical nose job. It is not a substitute, per se, for a surgical nose job, but it may be appropriate when the imperfections are relatively minor, for example, a tiny bump or a somewhat drooped tip. 

Augmentation of the tip will raise it and give a better profile. Likewise, placing the filler “above” and “below” the bump will hide it. Generally, the patients are very satisfied with this technique.

Your Consultation

Your nose job consultation should include an examination of the inside of the nose. 

This inspection is done to evaluate the breathing and internal structure. It evaluates the potential for improved breathing if one indeed has difficulties. 

Then, the outside of the nose is assessed by inspection and feeling to test the cartilage’s strength and the skin’s mobility. 

One needs to see the position of the nose when smiling. It only takes a few minutes to size up the situation and decide if surgical rhinoplasty is appropriate. 

“How Can I Prepare for a Non-Surgical Nose Job?”

Before a non-surgical rhinoplasty, there are only two steps needed. The first is to take medical-grade photographs, and the second is to prepare the nose by applying an anesthetic cream to the skin.

When done 45 minutes before the process, the skin is numb and makes the penetration of the skin by a needle and cannula virtually painless. 

There are very few side effects. The process is quick, and there is no downtime.

Unlike surgery, which is performed under an anesthetic and requires a pre-op and physical exam, none of that preparation is necessary.

What to Expect With a Non-Surgical Nose Job

The non-surgical rhinoplasty, the so-called “liquid rhinoplasty,” is the injection of a dermal filler through the skin into the thin space between the skin and the underlying rigid frame composed of bone and cartilage. It is a “plumper.” 

By such inflation, the plastic surgeon creates an illusion that the underlying framework’s imperfections have been positively altered. 

The result is not apparent to the eye nor to feel. It is the most simple and direct way to alter appearance without plastic surgery.

Your Procedure

  The skin is anesthetized using a topical anesthetic. The injectable filler is deposited between the skin and the underlying bone or cartilage using a special cannula. It can be injected into the tip or bridge, the two primary regions of the nose. 

The desired result is immediate. Temporary injectable fillers such as Restylane® and Juvéderm®, composed of hyaluronic acid, a compound in the skin and cartilage, correct the imperfections in one session. 

Medical-grade liquid silicone, marketed as Silikon 1000, the sole permanent filler, is distinct from these temporary dermal fillers. When this product is employed, multiple micro-droplets are injected. 

Also, the process is typically conducted during three sessions to allow nature to accommodate best and wall off the filler in the injection location to prevent dissipation into adjacent areas.

Your Recovery

Non-surgical rhinoplasty is indeed non-surgical. It is done in an office setting and requires little preparation. There is no recovery time.

What Can You Not Do After a Non-surgical Nose Job?

There are no consequences of having the office treatment. You leave the office and resume your life. 

There are no constrictions other than advice not to rub the nose once the liquid material is placed under the skin. Nature likes to have quiet and nondisturbance. 

Typically, there is a six-week interval between the first and second and then subsequent treatments. 

This period gives nature time to accept the material, form a microscopic wall about it, and thus, maintain its position.


The results of rhinoplasty or non-surgical rhinoplasty can be life-changing. The nose is the most prominent facial feature. 

For ladies, having a beautiful face with a very unsavory nose is difficult.

The large nasal tip or the dorsal hump is often extremely unsatisfactory and detracts from other pleasant facial features. 

It has been said that “When you perform plastic surgery, you perform brain surgery.” 

There is much wisdom to that statement because self-perception is heightened, which is essential for improved self-satisfaction.

Non-Surgical Rhinoplasty Before and After Example

Below is an example of how Dr. Kotler’s superspecialization has helped clients improve their confidence and appearance.

Patient August consulted Dr. Kotler because he was dissatisfied with two nose features.

The first was that his nose bridge was too low, which made his nose look too small.

Second, August’s nose was asymmetrical and looked a little crooked. It looked that way because his nose’s right side and upper portion were somewhat recessed.

Dr. Kotler felt the patient did not need rhinoplasty or cosmetic nasal surgery. He believed that permanent fillers could achieve August’s desired result.

During the saline demo, Dr. Kotler administered anesthesia at the root of the patient’s nose. 

Then, the doctor injected some temporary filling on the nose’s side. After looking in the mirror to see the changes made to his nose, August was amazed and immediately asked when he could “get the real thing.”

Dr. Kotler then explained that the permanent filling technique requires gradual injection.

August’s experience is one of many testimonials and success stories on Dr. Kotler’s page.

These patient reviews show what a doctor at the top of the specialty totem pole can do.

Permanent Non-surgical Rhinoplasty in Beverly Hills, CA

Dr. Kotler is one of the world’s most specialized and experienced nasal surgeons practicing permanent non-surgical rhinoplasty

With over 40 years in practice and over 5000 nasal procedures performed, he is the most experienced practitioner of permanent non-surgical revision rhinoplasty in the United States. 

Dr. Kotler is a published medical author and a highly-rated teacher at UCLA (University of California, Los Angeles) and USC (University of Southern California), frequently speaking at medical meetings. He is an inventor and founder of two devices used in nasal surgery.

The “magic” of Dr. Kotler’s permanent non-surgical revision rhinoplasty is that one sees immediately in the mirror the benefits. “What you see is what you get.” The results are permanent. 

Contrast this with the use of temporary fillers. There is no similarity between temporary fillers, generally derived from collagen-like material destined to be degraded by the body, and medical-grade liquid silicone, which the body views as “acceptable.” 

Thus, medical-grade liquid silicone may permanently reside in the nose without the significant threat of rejection. 

The permanent non-surgical revision rhinoplasty is extremely important to those patients who have had one, two, three, or more unsuccessful surgical rhinoplasties. 

The prospect of yet another rhinoplasty surgery with the uncertainty of the outcome is a dim prospect for such patients. 

They are extremely happy to know about and then benefit from the finality of the permanent non-surgical revision rhinoplasty. Finally, the plague is over.

Silikon 1000 Specialist

Injection of Silikon 1000 is an art form that rests in the hands of a skilled practitioner. It is challenging to learn because it is permanent. 

One learns best from an experienced preceptor or trainer. Dr. Kotler was fortunate to have that experience very early in his career. 

Dr. Kotler observed that this technique would be a marvelous adjunct to a cosmetic nasal surgery practice. 

There is a virtue in superspecialization with an intense focus on a very limited field of cosmetic work. 

Generally, superspecialists are the ones that engender the greatest confidence on the part of the patients.


No. The essence of this nose job treatment is using micro-droplets injected just beneath the skin. The droplets are immediately walled off and contained by nature’s healing process. 

The cosmetic procedure’s effect is unlike a solid implant in which some potential for movement exists.

Yes. The silicone is incorporated into nose tissue, and the skin is raised during the rhinoplasty. Therefore, a filler is not a contraindication to a surgical rhinoplasty.

Yes. It is possible but extremely rare. It is so rare that Dr. Kotler has yet to see a full-blown infection in the 46 years he has been performing the procedure. 

Some people will get a reddish reaction that appears to be an infection but tends to be more of a bodily response to the foreign material than caused by the bacteria.

But, a frank infection with all the significant consequences is extraordinarily rare. 

Unlike most nasal surgeons, Dr. Kotler’s permanent non-surgical revision rhinoplasty results are instant. You can expect to see mirror-in-hand rhinoplasty results with little to no touch-ups required.

The entire treatment usually lasts from 10 to 20 minutes. It is performed with local or topical anesthesia to minimize potential pain, and patients can resume daily activities after their procedure.

Non-surgical rhinoplasty is indeed non-surgical. It is done in an office setting and requires little preparation. There is no recovery time. 

Surgical rhinoplasty typically can address many more problems, including breathing problems, but it is an operation. 

It is conducted in an outpatient surgery center under anesthesia. There is a seven- to ten-day recovery period. The costs are significantly different. 

An ideal result from a surgical rhinoplasty cannot be warranted. Therefore, it is necessary for some patients to have a revision rhinoplasty. 

At that point, the question should arise as to whether the revision should be a temporary non-surgical revision rhinoplasty or a permanent non-surgical revision rhinoplasty.

The procedure is quick and virtually painless. It involves using an anesthetic cream applied to the nose 45 minutes before the appointment.

In the case of the permanent variant using medical-grade liquid silicone, nature builds a capsule around the liquid, therefore maintaining its position. This procedure takes place over six weeks.

From a practical perspective, one cannot remove Silikon 1000. 

If one ever had to have some other reason for operating in that area underneath the skin and close to the bone and cartilage, the surgeon would notice that the treatment area filled with silicone is indistinguishable from the non-filled one.