FPSAM - Roundtable - 1


Effective Techniques in Managing
Nonsurgical Rhinoplasty
Moderator: Steven Dayan, MD1
Participants: Sebastian Cotofana, MD, PhD,2 Kay Durairaj, MD,3
Lisa Grunebaum, MD,4 and Alexander Rivkin, MD5

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Illinois,
Chicago, IL, USA.
Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
Beauty by Dr. Kay, Pasadena, CA, USA.
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Miami
Miller School of Medicine, Miami, FL, USA.
UCLA Medical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.

Dr. Dayan: This is a roundtable discussion on nonsurgical fillers and safe and effective techniques.
Fillers are now commonly being used in the nose;
however, the potential for a vascular occlusion and/or a life-altering complication has a significantly
greater relative risk with nasal filler injections than
when treating other areas of the face with fillers.
This is perhaps attributable to the highly vascular
nature of the nose, the unique anatomy, the probability of treating a patient who has had a previous
rhinoplasty, the technique employed, or the devices
used. In addition, achieving an aesthetically ideal
outcome in rhinoplasty is a learned art. Therefore,
the nose serves as a peculiar feature of the face with
many nuances, facets, and caveats to consider before
treating it with fillers. To get a more complete view
through a wider lens for evaluating best practices
when using fillers in the nose, we have decided to
reach out to four experts with divergent views and
techniques. We intend to come to some consensus on
treating the nose with fillers. So, first I want to start
with Alexander (''Sasha'') Rivkin. Sasha, can you
tell us in your opinion who a candidate is for nonsurgical soft tissue fillers for rhinoplasty?
Dr. Rivkin: In my opinion, the people who are candidates for nonsurgical rhinoplasty are those who have
a mild-to-moderate aesthetic contour irregularity of
the nose that they would like to correct, and who want
to avoid surgery.
ª 2020 by American Academy of Facial Plastic and Reconstructive Surgery, Inc.

There are relative contraindications and more absolute
contraindications. So if the nose primarily needs reduction, that is a contraindication. If the nose has a very
droopy tip (more than 45°) or the dorsum is extremely
low, for example, depending on the expectations of the
patient, fillers may not be able to do what needs to get
done aesthetically. But overall, the majority of people
who desire change without surgery are candidates.
Dr. Dayan: Lisa, do you treat tips of noses, dorsums,
or both?
Dr. Grunebaum: I will treat both. I actually agree
with Dr. Rivkin that augmentation is the best indication, in particular radix disproportion.
Dr. Dayan: Okay, and then what about age? Do the
participants in this panel have a limit as to age
ranges of patients that you will treat?
Dr. Rivkin: No. I have treated patients in their 80s, so
I do not have an upper age limit. As far as a lower limit,
I have treated patients as young as 12 years old. The
reason I treat them is because filler is safe and provides
a temporary solution to their aesthetic concern. As
these patients grow and their facial anatomy changes,
a filler is not going to affect those changes. Of course,
I will only treat these patients after a careful consultation involving their parents, during which I make
sure that their expectations are reasonable and they do


FPSAM - Roundtable

Table of Contents for the Digital Edition of FPSAM - Roundtable

FPSAM - Roundtable - Cover1
FPSAM - Roundtable - Cover2
FPSAM - Roundtable - i
FPSAM - Roundtable - ii
FPSAM - Roundtable - 1
FPSAM - Roundtable - 2
FPSAM - Roundtable - 3
FPSAM - Roundtable - 4
FPSAM - Roundtable - 5
FPSAM - Roundtable - 6
FPSAM - Roundtable - 7
FPSAM - Roundtable - 8
FPSAM - Roundtable - 9
FPSAM - Roundtable - 10
FPSAM - Roundtable - Cover3
FPSAM - Roundtable - Cover4