Filler Rhinoplasty by Dr. John Burroughs

This patient had never been pleased with her bulbous nose tip that was very broad at the tip and the nasal “swoop” instead of a nice bridge.  She had a syringe of Restylane Lyft hyaluronic acid filler injection using a 22G cannula to improve and reshape her nose.  She was delighted with her immediate results, no bruising, and no downtime.  She liked that she now had a nasal bridge instead of the swoop and the filler especially in straight-forward gaze made her displeasing bulbous nose tip look more narrow. Results can last for a year.  Nose injections can be higher risk than other areas of the face, so seeking an injection by a well-trained qualified specialist is key not only for an optimal result but also in the safest manner possible.  The 22G cannula is used by Dr. Burroughs because it is safer, more comfortable, and lessens bruising risks.  It’s safer as it is of sufficient size to minimize the risk of a direct injection into a blood vessel that could cause skin necrosis or even blindness.  Dr. Burroughs prefers to use Restylane Lyft for the nose because of its higher G’ (stiffness) and because it can be readily dissolved with hyaluronidase enzyme in the event of blockage of blood flow.  Patients should always be able to have filler dissolved with enzyme and should ask the person injecting them if enzyme is on site.  Hyaluronic acid fillers are all dissolvable with enzyme, but some fillers like Sculptra and Radiesse are not.  For these reason, Dr. Burroughs only injects hyaluronic acid filler in the danger zone areas of the face especially under the eyes, nose, and glabella.  Dr. Burroughs is a sought after injection expert with 20 years of experience.  He teaches at national symposia and has published on injecting safer.  His practice has received patients as far as California and New York.

Filler Infection: Be sure your injector is professional, competent, and can manage complications.

This patient received hyaluronic acid filler on a cruise several months earlier.  Sterile technique was questionable, and she has suffered months of chronic redness, purulent discharge, and hard/painful nodules.  She presented for help in managing these issues. She had been on multiple courses of oral antibiotics without improvement.  Dermal fillers should be considered like an implant, and can have more resistant to treat infections because of what is called a “biofilm” that develops.  Biofilm acts like a scaffolding that allows bacterial infections to become dense and protected from a more typical response to oral antibiotics.  Studies have shown regular antibiotic concentrations against the bacteria simply are not enough for biofilm infections.  Simply increasing concentrations of antibiotics isn’t a good solution either as side-effects risks go up even though the concentrations remain too low to clear the infection.

Shown is a syringe of 1.5 cc of purulent material that had been aspirated from the right nasolabial fold area.  The patient reported these hard and red areas would keep showing up on the surface of her skin in the areas she had been injected.  Dr. Burroughs has been referred these infections from different injections done elsewhere several times previously.

This patient fortunately had a hyaluronic acid type filler, which is amenable to enzyme reversal with hyaluronidase.  Not all fillers are enzyme reversible.  Non-reversible fillers include Radiesse (hydroxylapatite), Bellafill, and harvested autologous fat.  Hyaluronic acid fillers belong to several company “families” that include Allergan’s Juvederm, Merz’s Bellotero, and Galderma’s Restylane.  Juvederm older fillers are amenable to enzymatic reversal while their newer Vycross fillers are much more resistant to enzymatic reversal.  Restyalane fillers remain among the easiest to reverse with enzyme while Belotero is reversible but can take more enzyme than Resytlane.

This patient did not know what filler had been injected therefore high concentration of enzyme was injected after withdrawing the purulent build-up as shown in the photo.  She required additional injections, but the use of the enzyme allowed the infection to clear.  She had suffered for 4 months prior to seeing Dr. Burroughs, and was very grateful for his help and resolving months of suffering.

Dr. Burroughs teaches at national and international cosmetic symposia on both basic and advanced wrinkle blocking and filler injections.  Critical to safe injections is that the injector is well trained, knows the pertinent anatomy, the properties of the injectables, thorough cleansing prep of the skin, available/sufficient enzyme on site, and specific expertise with site-specific fillers and use of large bore cannulas (22G to 25G are best and safest to minimize the risk of injecting into a blood vessel that can lead to skin necrosis or even blindness).

Dr. Burroughs emphasizes these safety principles when he is teaching at cosmetic conferences.  He cares deeply about patient safety followed closely by experience and results.  He is referred and has seen patients from coast to coast and even internationally.