Renowned Facial Plastic Surgeon Dean M. Toriumi says, "Injectable Fillers Used in the Nose Can Be Devastating!"

    MARINA DEL REY, CA, January 06, 2010 /24-7PressRelease/ -- A new trend in cosmetic practices is to inject filler materials into patients' noses to improve nasal shape or correct deformities. These procedures, performed by plastic surgeons, dermatologists, and aestheticians, are designed for patients to change the shape of their noses. While many patients are attracted to this option, known as "non-surgical rhinoplasty," to avoid surgery and minimize costs, there are many potential downsides to this treatment, and complications can occur, said Dr. Dean Toriumi, a facial plastic surgeon at the University of Illinois at Chicago.

"Many filler materials are available, but there are a number of potential issues and dangers that make using these fillers more complicated than some people would think," Toriumi said. There are the hyaluronic acid filler materials such as Restylane, Juvederm and Perlane. Other fillers are semi-permanent, such as Radiesse, which is composed of calcium hydroxyapatite. Permanent fillers include silicone and Artecoll/Artefill. There are also collagen fillers, such as Cosmoplast and Cosmoderm. Of these materials, the hyaluronic acid fillers are probably the safest, as they will resorb in approximately 6 to 10 months. Additionally, if the patient does not like the result of the hyaluronic acid filler, an enzyme known as hyaluronidase can be injected into the treated area to degrade the filler material.

To see photos and success stories of other patients Dr. Toriumi treated, please visit the section of his website at http://www.deantoriumi.com

Regardless of the filler used and its components, there can be problems with injectable fillers when they are used to change the shape of the nose, Toriumi said. For one, the person who is injecting the filler must have a good understanding of the anatomy of the nose and proper aesthetics of the nose. If not, the person injecting the filler may create abnormal shapes that can deform the nose.

One of the more common uses for injectable fillers is to raise the nasal bridge to create a narrower appearance to the bridge of the nose, Toriumi added. This practice is particularly popular in Asia. In order to create a well defined nasal bridge, a solid material should be placed on the nasal dorsum. Solid materials will create a contour similar to the natural bone and cartilage that constitutes a normal nasal bridge. If a filler material is injected on the nasal dorsum, it creates an amorphous shape that does not have definition, Toriumi said.

"In this case, the bridge will look higher but will also look wider and lack good lines of definition. A normal appearing nasal dorsum has well-defined brow-tip aesthetic lines that define the nasal dorsum." With filler injections, the dorsum may lack definition and can look unnatural and wide, Toriumi said. Additionally, the dorsum of the nose feels soft and unnatural. In some cases the filler material can migrate and create strange deformities, he added."

Dr. Toriumi is a facial plastic surgeon in Chicago who specializes in secondary rhinoplasty. He corrects noses in patients who have undergone unsuccessful rhinoplasty surgery. Toriumi sees many patients who come in with devastating complications from undergoing injections with filler materials. Unfortunately, many of these patients have permanent damage to their noses and can never be returned to normal. The image below shows a patient who had silicone injected into her nose that resulted in a bad tissue reaction and extensive scarring that required major reconstructive surgery to correct.

Toriumi sees problems with all filler materials used in the nose. Most of the problems are seen in patients who have undergone previous rhinoplasty and then undergo injection with a filler material to correct an imperfection. What can happen, he said, is that the filler material can inadvertently be injected into a blood vessel and block the blood supply to the skin of the nose resulting in permanent skin damage or even skin necrosis. Other patients experience infection after injection that creates the permanent damage. Patients who have undergone previous rhinoplasty surgery are at greater risk because the blood supply to their nose may be compromised and less able to withstand insult.

Dr. Toriumi has identified a new phenomenon in which the filler material is replaced with scar tissue that creates many irregularities of the skin covering the nose. He sees scarring in patients who have undergone previous injection with hyaluronic acid filler materials. Once the skin over the nose becomes bumpy and irregular, Toriumi says, future surgical correction becomes exponentially more complex, and patients are frequently left with residual deformity despite placement of smooth cartilage grafts for reconstruction. In these cases, patients are forced to live with permanent irregularities in their nose despite multiple corrective surgeries. "Secondary rhinoplasty is difficult enough without having to add another level of complexity due to previous injectable filler materials, Toriumi said. "That's why in my preoperative questionnaire/preference sheet, I ask all patients undergoing surgery if they had previous fillers placed in their nose."

Toriumi has performed revision rhinoplasty on many patients who have undergone previous treatment with injectable filler materials, and notes that these operations are usually more difficult and fraught with an increased potential for complications, such as infection and skin changes. Patients with thin skin are particularly susceptible to problems with filler materials, he said.

Dr. Toriumi's advice to patients is that if they are not planning on having surgery on their nose and would like to undergo treatment with a filler material, they should consult with a physician who is knowledgeable of the nasal anatomy and aesthetics. Additionally, the patient should only consider one of the hyaluronic acid fillers, as they are temporary and can be removed with hyaluronidase. Toriumi believes that patients should avoid semi-permanent and permanent filler materials because, if the person injecting the filler makes a mistake or patients do not like the outcome, they may be left with a permanent deformity. If they seek surgery to remove the permanent filler material, the surgery is risky and can leave permanent skin damage.

"The use of hyaluronic acid fillers for small nasal irregularities may be safe but must be injected by an experienced user and special care must be taken to avoid injecting into a blood vessel," Toriumi said. "Patients who have undergone multiple previous surgeries on their nose or who already have damaged nasal skin should avoid use of any filler materials, as additional insult to their skin may result in permanent skin damage and deformity."

Use of filler materials in the nose may be quick and easy, but once a patient has a complication, he or she may be spending the rest of his or her life trying to get back to normal.

Dr. Dean Toriumi is a professor in the Division of Facial Plastic and Reconstructive Surgery and Department of Otolaryngology - Head & Neck Surgery at the University of Illinois at Chicago. He is a Past President of the American Academy of Facial Plastic and Reconstructive Surgery. Dr. Toriumi has published four textbooks and more than 120 scientific articles, and has made more than 700 presentations on rhinoplasty and other topics related to facial plastic and reconstructive surgery. Dr. Toriumi specializes in aesthetic and functional rhinoplasty and is one of the most experienced rhinoplasty surgeons in the world.

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