More Caution Required for Fillers as a Rhinoplasty Alternative

There is an increasing demand for less invasive procedures today, particularly nose job procedure. And this trend gave rise to filler injections as an alternative to surgical rhinoplasty. 

However, Dr. Steven Dayans, M.D., F.A.C.S., said that this procedure is not without any potential serious complications.

In a recent Vegas Cosmetic Surgery and Aesthetic Dermatology meeting in Las Vegas, Dr. Dayan said that two of the major complications involved in filler injections for the nose are blindness and necrosis. That is why for those who are looking for nonsurgical options thinking that it is safer and quick, Dr. Dayan urges them to take more caution.

He said that impending necrosis occur more frequently in these cases and they are underreported. He underlines the importance that this be recognized so that prompt treatment is given within 24 hours. This serves as a reminder also to patients to only get their procedure done by a certified and trained doctor to make sure that fillers are administered safely in the right areas.

Dr. Dayan also said that the concern here is not just about injecting in the right place but it also has something to do with the fillers used, and injections made below the submuscular aponeurotic system. This goes to show that just because something sounds to be so simple and less invasive, means that anyone can perform them.

There are many blood vessels on the side and creases of the nose. With this Dr. Dayan referred to a presentation in Korea where the presenter recommended staying within the midline of the nose when injecting. This is to avoid the large vessels outside of that area.

In his practice, Dr. Dayan explains, “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.” Today he injects through the tip but with the use of a cannula.

Through a small needle port with the use of a 22-guage needle, then with a 25-guage blunt tip cannula, he injects the filler through the tip. Through this he is able to recreate or improve the bridge of the nose, while making sure that he stays in the bone and away from the vessels.

He also thins out the fillers with lidocaine in order to decrease their viscosity. This enables the filler to less likely result to embolization.

Dr. Dayan believes that using fillers is best for those patients whom he refers to as “near miss rhinos”. It means that they only require small corrections such as filling out nasal humps. It is also an excellent method to correct secondary defects from a previous surgery.