A practical approach to non-surgical rhinoplasty
Surgical rhinoplasty is one of the most popular aesthetic procedures worldwide. However, until recently, patients who wanted to avoid surgery – and the associated risks, recovery and expense – have never had a viable, non-invasive alternative that could accomplish similar cosmetic goals. Capitalizing on the advent of long-lasting injectable fillers, non-surgical rhinoplasty (NSR) can correct mild or moderate cosmetic nasal irregularities, following cosmetic goals:
- Raise and better define an underdeveloped nasal dorsum.
- Raise and better define a ptotic tip.
- Camouflage a dorsal bump. The dorsum is leveled by injecting filler above and below the bump.
- Correct asymmetry of the tip or dorsum by subtly augmenting the weaker side.
- Correct post-rhinoplasty contour defects. Most commonly, these present as saddle nose deformity or other types of dorsal cartilage collapse, poly beak deformity, dorsal asymmetry due to asymmetric scarring, asymmetry of the tip due to post-surgical scarring or cartilage over-resection and alar foreshortening.
Not all patients are candidates for the NSR procedure. Some are better served by a surgical approach. Most of these can be grouped together as patients who need a reduction of their nose. They include:
- Patients with a large nose who want a reduction.
- Patients with a tip that is large and round who desire a smaller, sculpted tip. This is especially so with patients who have thick tip skin.
- Patients with a severely twisted nose.
- Patients with wide ala who want narrowing of their nasal base.
- Patients with an overly projected nose who want de-projection.
- Patients with a hanging columnella.
NSR should be performed with the patient sitting straight up, as close to 90 degrees as is comfortable, leaning their head against a head rest to minimize movement. Injecting the patient in this position allows the practitioner to constantly re-assess the aesthetic effect of the nasal injections on the appearance of the entire nose and the patient’s face as it is viewed by others. Injections are performed, for the most part, as tiny boluses or as short linear threads at the level of the periosteum or perichondrium, placing small amounts of filler as I withdraw the needle. Filler will be placed into the area of the radix, dorsum, sidewall, tip, columnella and ala as needed to correct each individual irregularity; then massage and mold the filler will blend the desired contour. The volume effect of most fillers decreases by about 25% within the first couple of weeks, so touch-up visits are recommended after the initial procedure.
When performed carefully, NSR is a safe and simple procedure that makes patients extremely happy. However, this is a procedure with more risk than many other facial injections. It should only be performed by experienced injectors who understand fillers well and are very familiar with the anatomy of the face. The injector must know how to recognize adverse events like ischemia and intravascular embolism of filler as they happen, and be comfortable with treating these types of adverse events.
For more information visit: http://www.myplasticsurgery.gr/media/1151/secondary_rhinoplasty_fixations_with_hyaluronic_acid.pdf
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