B.C. naturopaths can't perform liquid nose jobs

The popular procedure, marketed as a quick and easy non-surgical alternative to a nose job, carries risk of blindness and necrosis.

Emma Jones 4 minute read December 31, 2020
A woman getting a liquid nose job sits with her eyes closed in a clinic chair

Dr Asaria (not pictured), director or FACE Toronto, explains that there are lots of blood vessels in the nose which supply important areas with blood.

The College of Naturopathic Physicians of BC has banned liquid nose jobs, a procedure marketed as a temporary and non-surgical alternative to the traditional surgical nose job.

Liquid rhinoplasty involves the injection of fillers, such as hyaluronic acid, into the nose to temporarily change its shape. The College cited serious health risks and noted that naturopathic registrants are not able to refer patients to medical specialists in cases of emergency.

“The College made the decision to not permit liquid rhinoplasty to be performed by registrants because of the serious side effects and risks associated with the procedure,” Howard Greenstein, the registrar of the College of Naturopathic Physicians of BC, wrote in a Notice to Registrants.

“These side effects and risks can include vascular necrosis, blindness, and stroke.”

The ban comes on the heels of an ongoing lawsuit where a patient claims the procedure led to a perforated sinus and fractured upper jawbone. The naturopath who completed the procedure denies responsibility.

Licensed physicians across Canada are still permitted to complete the procedure.

For Dr. Jamil Asaria, director of FACE Toronto, a surgical and non-surgical clinic in Toronto, and a lecturer at the University of Toronto, this move is unsurprising considering the risks that come with the procedure.

“The nose is a tight space, so there’s not a lot of room for expansion of the filler. It can easily block a blood vessel, and there’s lots of blood vessels in the nose that are supplying very important areas,” says Asaria. “Even many highly experienced dermatologists and surgeons who have years of experience injecting [fillers] will often avoid injecting the nose because of that risk of complication.”

Risks always present with fillers

“The biggest serious risk of fillers is that of vascular occlusion [which] means blocking a blood vessel with the filler,” says Asaria. “There’s thousands of blood vessels in the face so whenever we’re injecting, we’re injecting in a careful manner.

“We know where the blood vessels are, we’re trying to inject in the areas they are least likely to be and we’re trying to use techniques that are as safe as possible to avoid blocking these arteries.”

Blocking these blood vessels, either through the filler entering the vessels themselves or putting pressure on them from the outside, can cause serious damage to the skin and may result in necrosis, where sections of the skin die from lack of blood. In extreme instances, a blockage may also cause blindness or stroke.

A 2015 review of reported incidents of blindness from injectable fillers found that although the risk is relatively low, “virtually every anatomic location where filler is injected on the face is at risk for blindness.” Cases have been reported from even small injections of 0.5 ml or less.

The article suggests fillers can cause blindness if the injection pierces one of the many small branches of blood vessels that feed the eye and eye area. The filler may be able to travel backwards up these vessels until it either partially or completely blocks critical points. This risk is increased by the fact that many blood vessels branch off of the main ophthalmic artery (which supplies the eyeball and surrounding muscles with blood) and project onto the nose and forehead.

To avoid blocking or putting pressure on these arteries, the practitioner must have thorough knowledge of facial anatomy.

“As long as the physician or nurse during the treatment is aware of the latest techniques and aware of the anatomy, that risk is minimized. But we always say there is a risk. It’s never zero, doesn’t matter in whose hands,” says Asaria.

For those still interested in the procedure, Dr. Asaria recommends finding a practitioner who is able to evaluate the many options patients have and provide a balanced recommedation.

“I think it’d be good to go to somebody who can give you a balanced opinion, like the risks and benefits of surgical and non-surgical, and whether you’re a good candidate for each one,” says Asaria. “A lot of times people are trying to do it in a non-surgical way whereas a surgeon would just say that’s not a good way to treat that particular problem.”



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