Fillers as alternative to rhinoplasty require caution

June 25, 2013

Patients are increasingly asking for nonsurgical alternatives to rhinoplasty, according to Steven Dayan, M.D., F.A.C.S., but the procedure is not without potential serious complications.

This article is part of the Vegas Cosmetic Surgery and Aesthetic Dermatology Show Coverage.

 

Patients are increasingly asking for nonsurgical alternatives to rhinoplasty, according to Steven Dayan, M.D., F.A.C.S., but the procedure is not without potential serious complications.

More patients are asking for nonsurgical options because it seems like an attractive, quick fix. Dr. Dayan urges caution, however, when using fillers around the nose. Necrosis and blindness are two major complications that can result, says Dr. Dayan, who spoke about using fillers in the nose at the Vegas Cosmetic Surgery and Aesthetic Dermatology meeting in Las Vegas.

Impending necrosis is happening more frequently, and it’s underreported, Dr. Dayan says. It must be recognized and treated correctly within 24 hours.

In illustrating the anatomy of the nose, Dr. Dayan noted that it’s not just injecting in the right place, it also has to do with the properties of the fillers themselves, and injecting below the submuscular aponeurotic system. Dr. Dayan called out the location of many of the blood vessels, which reside on the sides and creases of the nose, and repeated a recommendation he picked up from a presentation in Korea in which the presenter recommended staying to the midline with injections to stay away from the large vessels.

Dr. Dayan says the best case for using fillers in the nose is for what he calls “near-miss rhinos.” These are patients in need of only small corrections, such as filling in a hump. In this instance, he says he makes a small needle port with a 22-gauge needle and then uses a 25-gauge blunt tip cannula to inject filler through the tip and recreate the bridge. Dr. Dayan makes sure to stay on the bone, below the vessels.

“I used to stay completely out of the tip because I was concerned the tip was a really high risk for complications, especially for compression necrosis,” Dr. Dayan says. Now he has begun injecting through the tip, but only with cannulas.

Dr. Dayan also noted that he thins his fillers with lidocaine; one reason he takes this approach is because he feels that by decreasing the viscosity of the filler is less likely to result in embolization.

Dr. Dayan says the bottom line is that if somebody is not a candidate for rhinoplasty, if they’re asking for a filler, or if they have a secondary defect, fillers can help in this region. According to Dr. Dayan, there is evidence that filler corrections persist for at least a year and maybe longer.

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