The Art and Science of Non-Surgical Rhinoplasty: What Every Skincare Professional Needs to Know

As an esthetician with over two decades of experience, I've always been fascinated by the intersection of medical aesthetics and traditional skincare. Recently, on our Facially Conscious podcast, I had the privilege of hosting two brilliant minds in the field of facial aesthetics—Dr. Alexander Rivkin and Dr. Brandyn Dunn—for an in-depth discussion on non-surgical rhinoplasty and BellaFill in the podcast episode titled " Bellafill and Other Nose Enhancements: What You Need to Know. "

This conversation was significant because years ago, I observed Dr. Rivkin's procedures monthly, absorbing everything I could about his pioneering techniques. Those experiences shaped my approach to client consultations and referrals today, reinforcing my belief that estheticians must understand where our scope of practice ends and when to refer clients to medical professionals.

The Evolution of Non-Surgical Rhinoplasty

Dr. Rivkin shared the fascinating origin story of how he pioneered non-surgical rhinoplasty about 20 years ago. "Nobody had done this. Nobody was injecting noses," he explained. When he first appeared on shows like “Today” to demonstrate the procedure, audiences were astonished by the immediate transformation from a bumpy nose to a straight one without surgery.

What struck me most was how this innovation was initially deemed "sacrilege" by traditional plastic surgeons. Dr. Rivkin embraced the "heretic" label as "a mark of pride," pushing boundaries that have since become mainstream practices.

Dr. Dunn, a facial plastic surgeon, admitted that his early training made him wary of liquid rhinoplasty. Now, he incorporates it into his practice as "a stepping stone for many patients" who wish to visualize potential results before committing to surgery.

Understanding the Risks and Safety Protocols

Both doctors highlighted the significance of safety in nasal injections. Although complications are uncommon (approximately 1 in 1,000 cases), they can have severe consequences when they happen. These complications can vary from minor bruising to serious issues such as ischemia, necrosis, blindness, stroke, and, in extremely rare instances, death.

Dr. Rivkin explained that severe complications usually occur when filler enters blood vessels. He advocates for "universal injection safety precautions," including:

• Injecting small amounts instead of large volumes

• Continuously moving the syringe while injecting

• Establishing protocols to address complications promptly

Dr. Dunn added that "staying in the middle is the safest area" when injecting the nose, and "straying from the middle is when things become much more complicated."

This information is crucial for estheticians—not because we perform these procedures but because we must educate clients on the importance of seeking qualified providers. I've seen too many clients come to me with complications from procedures performed by poorly trained injectors.

Permanent vs. Temporary Fillers

One of the most intriguing aspects of our conversation was Dr. Rivkin's use of BellaFill, a permanent filler. While most doctors steer clear of permanent fillers due to safety concerns, Dr. Rivkin has successfully utilized them for approximately 13 years.

He explained that BellaFill has gone through several iterations (ArtePlast, ArteCall, ArteFill, and now BellaFill), each version becoming safer. The current product contains small, uniform beads of polymethylmethacrylate that promote collagen growth.

Dr. Rivkin typically starts patients with temporary fillers before suggesting BellaFill as an option. He injects it superficially, believing this method reduces the risk of vascular complications. However, he cautions that once you choose a permanent filler, "you're taking surgical rhinoplasty off the table forever."

Who qualifies as a good candidate?

Both doctors concurred that non-surgical rhinoplasty isn't suitable for everyone. Poor candidates include:

1. Patients experiencing functional breathing issues, despite Dr. Rivkin being "skeptical" of studies suggesting that non-surgical methods could enhance breathing,

2. Patients looking to significantly reduce the size of their nose

Interestingly, Dr. Rivkin noted that although fillers technically enlarge the nose, they can create the perception of a smaller nose by forming smoother, straighter lines that attract less visual attention. "It's really interesting... if you camouflage and make things look smooth and straight, it appears magically smaller," he explained.

Implications for Estheticians and Skincare Experts

As estheticians, we often serve as the first point of contact for clients with aesthetic concerns. Our role is not to perform medical procedures but to act as knowledgeable guides in the intricate world of facial aesthetics.

When I observed Dr. Rivkin's procedures years ago, I was not learning to perform them myself; rather, I was gaining insight into when and how to refer clients appropriately. This knowledge has proved invaluable in my practice and has helped me build trusted relationships with medical professionals.

During my experience with Esthetic Concierge, I've discovered that the most effective dermatology and medical practices effectively blend medical and esthetic services. When physicians and estheticians are aware of each other's roles and abilities, clients benefit from more thorough care.

For estheticians working in medical settings or privately with clients, understanding procedures such as non-surgical rhinoplasty enables them to:

• Thoroughly prepare clients' skin before procedures.

• Ensure that appropriate aftercare is provided.

• Identify potential complications requiring urgent medical attention.

• Set practical expectations about the outcomes of both non-surgical and surgical methods.

For medical offices aiming to expand their esthetic services, skilled estheticians who grasp the science and art of facial aesthetics foster a more cohesive patient experience.

The Future of Facial Aesthetics

What excites me most about conversations like the one with Dr. Rivkin and Dr. Dunn is seeing how the field continues to evolve. Twenty years ago, non-surgical rhinoplasty didn't exist. Today, it's a mainstream procedure with established safety protocols and training programs.

Dr. Rivkin mentioned that he offers preceptorships, allowing providers to observe or perform injections under his guidance. "It's fantastic to cultivate a community of individuals who are injecting noses with a comprehensive understanding of how to do it safely and effectively," he stated.

This collaborative approach to education—where experts share knowledge across specialties—is exactly what we need more of in our industry. At Esthetic Concierge, we promote these connections, enabling estheticians and medical professionals to learn from one another and provide better outcomes for clients.

Whether you're an esthetician aiming to deepen your understanding of medical aesthetics or a medical office seeking to improve your esthetic services, remember that knowledge and collaboration form the foundation of excellence in our field.

The conversation with Dr. Rivkin and Dr. Dunn reminded me of why I love what I do—being part of an industry that constantly evolves, challenges conventional wisdom, and discovers new ways to help people feel confident in their own skin.

If you want to expand your expertise in medical esthetics or deepen your understanding of it, Esthetic Concierge can help you achieve your goals. Visit Esthetic Concierge to discover more about our training programs and mentorship opportunities!

Want to hear the full conversation? Click here for the entire episode!