Episode 233 hosts Dr Alexander Rivkin (ENT surgeon based in California, USA)

For years injectors have argued bitterly about the pros and cons of theoretical safety manoeuvres performed when injecting fillers. These techniques include aspiration, small or larger movements of the needle tip or even aspiration and moving combined.

We explore the rationale proposed for these procedures and try to understand the merits and limitations of what they might offers us.

00:00 Introduction 01:35 Meet Dr Alexander Rivkin 02:34 From ENT to Aesthetics 04:55 Early Days and Marketing 08:05 Learning to Inject 10:16 Complications and Risk 13:31 Safety Versus Efficacy 16:50 Needle Motion Paper Debate 20:10 Critiquing the Model 27:33 Aspiration Explained 35:02 Bolus Versus Moving Technique 44:54 Teaching Safety to Beginners 47:05 Why Aspiration Feels Safer 47:25 Training Risks and False Confidence 48:15 Patient Comfort and Needle Motion 48:55 Legal Standards and Expert Battles 50:07 What Moving the Needle Means 52:11 Vasospasm and Early Ischemia 56:59 Ultrasound Promise and Pushback 64:15 Dissolving Filler and Integration Myth 67:48 Evidence Gaps and Practical Rules 71:11 Nose Occlusions and Management Steps 76:28 Why Keep Doing Nose Jobs 80:00 Origin of Nonsurgical Rhinoplasty 82:01 Wrap Up and Resources

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