- The Washington Times - Wednesday, November 19, 2008

Have you always wanted to get rid of the bump on your nose but been afraid of going under the knife? Now you don’t have to.

Many facial plastic surgeons are using the same kind of injectable fillers used to smooth wrinkles to straighten the kind of imperfections that used to cost thousands of dollars to fix, not to mention surgical recovery time.

The nonsurgical nose job takes about 15 minutes and uses common cosmetic fillers such as Radiesse or Restalyne .

A nonsurgical nose job costs $600 to $1,000, depending on how much filler is used, says D.C. dermatologist Dr. Dale Isaacson. A surgical nose job usually costs upward of $5,000.

One caveat: The results are not permanent. Most fillers last about 10 months to a year, which gives patients enough time to decide whether to repeat the procedure, do it again with a permanent filler or go for surgery.

“I say it is like taking a nose out for a test drive,” says Dr. Alexander Rivkin, a Los Angeles plastic surgeon who developed the procedure about four years ago.

Dr. Rivkin says the injectable nose job (rhinoplasty in doctors’ language) is a good option for a patient who has a minor flaw, such as a flat bridge or asymmetry. The filler is injected over the bones but under the skin. Injectables can give the illusion of smoother and smaller because the eye is not looking at the irregularity. However, injectables cannot actually make a bump smaller, he says.

And the injectables are not without controversy: An FDA advisory board met yesterday to review complaints that injectable facial fillers may have caused serious problems in some patients.

Using injectables in the nose is considered an off-label” use, meaning the fillers have not been approved by the FDA for use in that manner. At yesterday’s hearing, plastic surgeons and other independent advisers were asked for recommendations on how to monitor the long-term effects and potential risks of facial fillers.

FDA scientists presented data on 823 patients who suffered reactions after treatment - in various parts of the face - with fillers between 2003 and September 2008. There have been no deaths reported to the FDA, but 638 of the patients required follow-up medical treatment. Most reactions involved minor swelling and redness, complications that could be expected. However, the FDA also received reports of “serious and unexpected” problems, including facial, lip and eye paralysis, disfigurement, vision complications and some severe allergic reactions.

Dr. Isaacson says injectables are a good option for someone who is not certain he or she wants a permanent alteration in appearance. He performs the procedure using several types of fillers. Juvederm, a hyaluronic acid dermal filler commonly used for facial folds and wrinkles, is a popular first step because it is immediately reversible, he says.

Longer-lasting options are Restalyne, another hyaluronic acid filler, and Radiesse, which is composed of calcium hydroxylapatite. Another filler, Artefill, was approved in 2007. Artefill offers permanent results. Fillers also can be used for chin enhancement and to reduce jawline jowls.

Dr. Donn Chatham, president of the American Academy of Facial Plastic and Reconstructive Surgery, says nonsurgical alternatives are very trendy, but only time will tell if they are a long-lasting solution to cosmetic problems.

“I would say I favor easier ways to achieve good outcomes,” he says, “but this procedure has a limited application for a small group of patients.”

Dr. Chatham also says potential patients should understand that even though these procedures are not surgery, they still need to be done by an experienced professional.

“Because injectable procedures have gotten a lot of play on YouTube, people have this image it is like going to a spa,” he says. “This is still a medical material to be administered by a medical professional. There is always a possibility of a problem with a filler, and for most of them, they are not removable once they are in. These fillers are good, but I don’t think it is going to replace the traditional rhinoplasty.”

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