Hi Dr. Yang
I have been trying to find information about both artefill and silicone microdroplets as fillers for the nose. I’ve had a rhinoplasty and I love my results but I have minor indentations on the sides of my nasal tip which I was told might remain. I do not plan on doing further surgery in the future as I heard fillers will make it difficult to do so. I was wondering if you had any input as to which is better to fill these dents (longer lasting results, no migration, low risks for lumps or granulomas).
I look forward to hearing from you and I thank you in advance.
Injectables in the nose are considered an “off-label” use, so I can not advocate the use of either for the nose or anything other than their “on label” applications. Some surgeons are bold enough to take these off-label applications and promote themselves this way.
I will supply you with some insider information and history. Silicone microdroplets used as a filler is an off label use for medical grade silicone oil normal FDA approved for ophthalmic problems. The doctors and surgeons who do use the silicone microdroplet technique will continue to do so, but they rarely promote it and definitely know not to advertise these services.
Silicone microdroplets for filling minor indentations and irregularities from rhinoplasty has been used by a few rhinoplasty experts with good success. The track record is longer for silicone than Artefill. As you should also know, Artefill in the U.S. is now bankrupt, so if you do have any problems with these injections, there is no company that backs the product, and it may be hard to find these days. It is also possible that the last batches of Artefill may be close to expiration.
If you do plan to use a filler, why not first try a temporary filler such as Restylane or Juvederm (also an off-label use) to see if a filler will work well to camouflage the areas that you are concerned about. Your rhinoplasty surgeon, if he or she is nice enough may even “comp” you a few tenths of a milliliter of Resty or Juve that they may have leftover.
If it works you can also see how long it lasts in the nose. If it last about a year or more, then you may consider repeating it. There are some studies which suggest that repeated injections may build up some collagen. Depending on how deep the indentations are, this may be enough. If it is very deep then it may not work well enough. Although repetitive temporary fillers is not a great solution because of the upkeep, but it doesn’t prevent you from ever having a future rhinoplasty if the current one shifts or changes in a way that you don’t like. Hopefully it will stay exactly the same forever.
If you really like how the temporary filler looks, then you can revisit using a more permanent filler. Both silicone and artecoll have a history of delayed granuloma formation. Lumps and bumps is more injector dependent. Silicone probably lasts longer, but depending on the injection technique may have a higher chance of migration.
If you were a family member, I would advise you to avoid permanent fillers as well as Radiesse for the nose. Although no one wants to have a revision rhinoplasty, the early results of a rhinoplasty (less than 1-5 years) may not be permanent. How often have you heard on the rhinoplasty boards stories of people who may have had a good early result only later to have the nose change as the nose continues to heal over many years due to the “shrink wrap effect.” So before you “burn the bridge” of ever having a revision in the future think twice about permanent fillers. Early results do not equal “forever results.” I don’t mean to scare you, but I just want you to think things through before you commit to a irreversible treatment.