A nose job without the knife? Doctors say 'liquid rhinoplasty' isn't worth the risk

It was supposed to be a quick injection of filler into the base of Alyssa Nelson's nostrils that would leave her with a cute little ski jump at the tip of her nose.

Instead, Nelson claims in a lawsuit filed earlier this year, she "felt a popping sensation and a subsequent shockwave through her entire body. The attempted injection perforated her sinus, leading to filler being injected directly into her sinus cavity."

She alleges the 2019 injection by a Vancouver naturopath fractured her upper jaw bone, caused some of her teeth to die, and led to headaches, blurred vision, post-traumatic stress disorder and insomnia, according to a statement of claim filed in B.C. Supreme Court.

The procedure that allegedly caused so much trouble is marketed as "liquid rhinoplasty" or a "non-surgical nose job." It involves injecting dermal fillers — usually hyaluronic acid — into the nose to disguise bumps, change the shape of the nostrils, emphasize the tip or build up the bridge.

The effects aren't permanent, but more than a dozen doctors, naturopaths and nurses offer the procedure in B.C., advertising it as a relatively painless and quick alternative to going under the knife.

But doctors say there are serious risks — including death of the skin around the injection area or even blindness.

Dr. Andrew Dargie, who practises medical esthetics in Vernon and Kelowna and is department head of emergency medicine at South Okanagan General Hospital, said he's seen a proliferation of people advertising the procedure.

"I notice that seemingly on every second street corner, there are new medical professionals offering this. It's widely publicized on social media," he told CBC.

"This is a high risk treatment area for dermal fillers and typically one that should be reserved for people who have been injecting for many years and have lots of experience."

Dr. Erin Brown of Vancouver said he's "not 100 per cent sure" why anyone who's fully informed would choose to undergo liquid rhinoplasty, which can cost as much as $1,500 a session.

"That area at the top of your nose and between your eyebrows is an area that's frequently injected with these materials. Unfortunately, there's also a large number of blood vessels there that actually communicate with the blood vessels that go deep inside your head," said Brown, a clinical professor of plastic surgery at the University of B.C. and chief examiner for plastic surgery at the Royal College of Physicians and Surgeons of Canada.

By 2015, dozens of cases of permanent vision changes linked to the procedure had been identified around the world, according to a review of the scientific literature, including several people who are now completely blind.

Brown said he's treated patients with other unfortunate side effects after undergoing the procedure elsewhere, including the Tyndall effect, in which the skin takes on a bluish tint, and tissue necrosis or skin death.

"It's definitely not what people are anticipating when they have this done," he said.

Naturopath denies responsibility

According to Nelson's lawsuit, her procedure was performed by naturopath Jordan Atkinson, who works at The Vanity Lab in Vancouver. She accuses both Atkinson and the spa of negligence, saying Atkinson did not obtain her full informed consent.

None of her allegations have been proven in court.

In his response to Nelson's claim, Atkinson says he gave her adequate information about the risks involved and denies responsibility for any injuries. The Vanity Lab has also denied responsibility in its response and says it's not liable for Atkinson's actions because he is an independent contractor.

Neither Atkinson nor The Vanity Lab responded to CBC's request for comment on this story.

Dargie questions whether the procedure should be restricted to doctors and nurses working under their supervision.

"Performing a high-risk procedure while not being connected to the appropriate people in a hospital setting, it seems like inappropriate care, in my opinion," he said.

Any naturopath who performs liquid rhinoplasty has to be certified in providing injectable fillers, which means completing courses approved by the College of Naturopathic Physicians of B.C., according to college registrar Howard Greenstein. 

They also must be trained in advanced life support, and it's recommended they keep emergency medical kits in their clinic.

Nurses are only allowed to administer any dermal filler when it's under order from a patient's doctor, while the College of Physicians and Surgeons of B.C. says doctors "must have completed relevant medical education and training."

'The enemy of greatness is perfection'

Brown said that anyone who's interested in making cosmetic changes to their face should speak to a professional who can offer a range of options and explain all the advantages and disadvantages of each one.

"If you're looking for someone like that related to the nose, you're probably going to want to see an ear, nose and throat doctor or a plastic surgeon," he said.

Both he and Dargie generally discourage patients from liquid rhinoplasty, but they say anyone who provides it should be totally transparent about the dangers — and prepared to suggest that doing nothing is the best option.

"One thing that I learned in my training is that the enemy of greatness is perfection," Dargie said.

"A number of the people that come in wanting this procedure, it's for such a subtle change to their appearance, I don't think that that risk outweighs the benefit."