Nonsurgical Rhinoplasty

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Key points

  • Nonsurgical procedures are growing in popularity; rhinoplasty is among them.

  • The most common reason for nonsurgical rhinoplasty (NSR) is to correct dorsal irregularities, but tip rotation and projection, sidewall asymmetry, and even the nasal valves can be addressed.

  • While various fillers are available, hyaluronic acid and calcium hydroxyapatite based injectables are the most commonly used.

  • Injection should be in the supraperiosteal/perichondrial plane and aspiration is always recommend to reduce

Anatomy

The nose is a complex, multilayered structure and central esthetic feature of the face. Contour from the bony-cartilaginous anatomy, shadow lines, and skin quality all contribute to its appearance. In traditional surgical rhinoplasty, changes in the cartilaginous and bony nose affect the external appearance. In NSR, however, the material is injected into the skin-soft tissue envelope (SSTE) to take effect. The SSTE can be subdivided into the following layers: epidermis, dermis, superficial

Patient selection

The evaluation of a potential NSR patient proceeds identically to that of a surgical rhinoplasty patient. As with surgical rhinoplasty, understanding what specific concerns and motivations a patient may have is important to determine procedural candidacy. Assessment of the external anatomy and a thorough intranasal examination are just as important to an NSR patient as they would be to a preoperative surgical rhinoplasty patient. Because NSR techniques are relatively new, educating the patient

Injection materials

Several factors should influence the choice of filler used. Safety is of the utmost importance, but other considerations include longevity, viscosity, hydrophilicity, elasticity, and moldability [8]. The anatomic location of injection will help determine which type of filler to use as well. The biomechanics of different injectables and formulations most commonly used will be briefly reviewed. Table 1 lists some of these properties.

G prime (G′) refers to elasticity: the ability to resist

Basic Principles

  • Anesthesia: topical anesthesia is useful and recommended. Many formulations are available, such as topical 5% lidocaine or compounded benzocaine, lidocaine, and tetracaine. Some fillers come premixed with local anesthetic, others can be mixed with 1% lidocaine on opening. Care must be taken if using epinephrine as local blanching can mask the effects of vascular compromise [8].

  • Needle choice: small gauge (27–30) needles are recommended during injection. The injector may wish to make an entry

Complications

Complications of NSR may include bleeding, bruising, visibility, filler palpability, edema, asymmetry, or more serious complications, such as blindness, skin necrosis, and vascular compromise (Table 2). In a recent review using the MAUDE database, several complications were reviewed with very low (0.006%–0.008%) but statistically significant severe complications and higher rates (61%) for more minor complications, such as swelling [16]. Blood thinning medications and herbal supplements are

Outcomes

The importance of discussing the longevity of these injectable materials with patients is crucial as it pertains to anticipated long-term outcomes and patient satisfaction. With hyaluronic acid fillers, the lasting effect is determined by particle size, manufacturing processes, volume, injection location, and metabolism of the patient [20]. As mentioned, there is a wide variety of hyaluronic acid products manufactured that generally last from 6 to 12 months, but as little as 4 months and as

Summary

Given the growing interest in nonsurgical cosmetic procedures, it follows that NSR will increase in popularity in the coming years. Thus, we recommend that practitioners be familiar with this topic so they can provide safe services to patients, carefully select appropriate patients, and inject judiciously, being aware of the vascular anatomy of the nose and how to manage complications. The risk of complications can be reduced (but not eliminated) by injecting in the correct plane and always

Disclosure

The authors have no commercial or financial conflicts of interest or any funding sources to disclose.

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