PDF | Rhinoplasty is the most common operation performed by our facial plastic surgery unit. Recognition of Sorry, there is no online preview for this file type. . Use of silicone sheets for dorsal augmentation in rhinoplasty for Asian noses. This basic rhinoplasty operation is designed to allow the surgeon to do decision is whether the radix needs to be maintained, augmented, or reduced. .. grafts, and (3) extensive cartilage and bone en bloc especially in Asian rhinoplasty. Comparison of Artecoll, Restylane and silicone for augmentation rhinoplasty in Chinese patients. Clin Invest Med. ;E–E

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Rhinoplasty has traditionally been preferred for correction of nasal defects. Long-term clinical experience with hyaluronic acid HA injection as an alternative or complement to rhinoplasty is presented. More than patients were treated for nasal reshaping with HA since In addition to being a complement to surgery, HA injection successfully addressed nasal defects that would have been difficult to correct surgically.

No serious complications occurred. When comparing the 3 years reviewed in detail, new indications for nasal reshaping with HA gel became evident over time, which was also reflected by the increase in number of patients treated The mean injection volume was 0. All patients were satisfied with the primary outcome of treatment. Injection of HA gel is a valuable tool for nasal reshaping.

It can also be used for correction of minor postrhinoplasty defects in appropriate patients. Rhinoplasty was the fifth most common surgical procedure in In fact, enhancement of parts of the nose can lead to it being perceived as smaller. Despite the challenge to explain to patients who seek a nasal reduction that they would benefit from enhancement of parts of the nose, plastic surgeons should be aware of this effect.

Nasal reshaping may be achieved with injectables such as calcium hydroxylapatite 2 — 5 and stabilized hyaluronic acid HA. However, retreatment may be needed to maintain the filetyp aesthetic correction because HA degrades over time. The efficacy and safety of HA have been established for facial aesthetic indications, 16 — 23 but information on nasal treatments is limited; clinical experience 79 — 121415 and data from 2 small studies 8augmenttaion and 1 retrospective case series 24 have been described.

Here, the author presents his clinical experience of nasal treatments with HA during 15 years, with case descriptions to illustrate the use of HA as an alternative or complement to primary and secondary rhinoplasty. If the patient has thick nasal skin Fig. If the patient has thin nasal skin, HA gel can be used to mask protruding cartilage.

Case 1—to elevate low dorsum and increase tip definition. A, Pretreatment profile view of a healthy year-old woman requesting a reduction of her bulbous tip. She rejected augmentation surgery because she considered that her nose was already too big and had no previous nasal trauma or surgery.

B and C, There was a considerable difference in skin thickness when comparing the tip B and dorsum C. Reduction surgery was thus considered to be contraindicated, and the augmenfation agreed to try HA injection instead.

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Immediately after injection of 0. D, Two years after the last of 3 injections 2. However, after reviewing the before and after pictures, she was impressed to see that the effect actually still persisted and that the difference in appearance at 2 years after the last injection was relatively small filettpe with immediately after the injection.

Pretreatment analysis may also involve a 2-dimensional or 3-dimensional picture morphing to illustrate the estimated injection outcome. Injection into areas with signs of infections and acne should be avoided. The safety and efficacy profiles of lidocaine-containing HA gels are similar to those of corresponding products without lidocaine. See video, Supplemental Digital Content augmengationwhich shows nasal reshaping with 0.


Illustration of HA gel placement for nasal reshaping. A, Example of nasal profile. Common treatment requests include lowering of hump, shortening of the nose, lowering of the alar rim, and widening of the nasolabial angle. B, Example of desired nasal profile, which can be augmentatlon by adding volume rather than reduction of tissue.

C, Profile view of HA gel placement to achieve the desired nasal shape. D, Frontal view of HA gel placement to achieve the desired nasal shape. The illustration is published uagmentation permission from the copyright holder, Jenny Hanzon. Nasal reshaping; this video, Supplemental Digital Content 1, shows nasal reshaping with 0. Minute amounts of gel should be carefully injected, while gradually evaluating the change in shape and with bolus doses avoided to avert intravascular injection.

Small volumes of HA are usually sufficient for rhinnoplasty pronounced effect, filetypd in the nasal tip. Overcorrection should be avoided because this may produce a widened and less refined tip. Deep injection directly on the cartilages usually requires larger volumes of product and may widen the lower lateral cartilages. The most important difference between injections in alar rim versus alar sill is the risk for intravascular injections.

Along the rim, injection is done superficially in the intradermal plane; in the sill, more subcutaneous placement of the gel is needed for widening of the sill. Important anatomical considerations include augmentaton superficial vascular network and the potential risk of intravascular injections.

Serious complications, eg, blindness and facial skin necrosis, have been reported after HA injection in the nasal and periorbital region. Constant movement of the needle and injection of minimal volumes reduce the risk further.

Knowledge of vascular anatomy is of importance for avoiding such complications, 30 especially in patients who have had previous nasal surgeries.

Nasal Reshaping with Hyaluronic Acid: An Alternative or Complement to Surgery

The injected product should be smoothed out, not massaged. A full facial photographic documentation is recommended immediately after the treatment. Patients should avoid pressure and massage on the injected area for the first 1 to 2 weeks after treatment. A follow-up visit should be scheduled 6 to 8 weeks after, during which a full facial photographic documentation should be done and, if applicable, touch-up injection.

Before and after photographs are useful when discussing treatment results with patients. The frequency of nasal HA gel treatments changed from a few treatments per year to several treatments every week. In particular, the frequency of secondary surgical rhinoplasties markedly reduced although the total number of rhinoplasties did not decrease. Indications for nasal treatments with HA are broader than for conventional rhinoplasty Fig.

HA injection can be used instead of surgical rhinoplasty in patients unwilling to go through general anesthesia or when it is unsuitable for medical reasons. In some cases, HA gel injection can also be used as a complement to surgery or for correction of minor postsurgical defects, for instance, in those patients who are not candidates for secondary rhinoplasty and even those fairly satisfied with results of primary rhinoplasty.

HA gel can also be used in patients for whom nasal reshaping is required but for whom surgical rhinoplasty is unsuitable eg, psychological reasons, extent of previous surgeries. Secondary rhinoplasty can be more challenging than primary rhinoplasty and may be technically demanding.

In these instances, HA gel injections may also be useful as a simple alternative to surgery to evaluate how masking of the defect may affect its appearance. However, special attention must be given to any alterations in nasal vasculature resulting from previous surgeries. Flow chart illustrating that HA gel injections can be considered for most patients requesting nasal reshaping. Precautions auvmentation previous nasal surgery and any intervention that could affect the vasculature or increase risk of vascular compromise.


Nasal Reshaping with Hyaluronic Acid: An Alternative or Complement to Surgery

In general, precautions should be considered before rhinoplasty after a filler procedure in the nose. This is especially true if another physician has administrated HA in an unknown manner.

Careful examination including palpation of the nose is recommended. Thus, it is always important to avoid overfilling; only small amounts of HA should be used.

Among the 75 patients treated during, andthe average age was asjan years range: Mean injection volume was 0. Restylane Perlane Lidocaine was most commonly used. The reasons for secondary rhinoplasty include that duration of the filler was too short 2 patientsa more drastic effect was sought 1 patientand the HA injection was a door opener for rhinoplasty 2 patients. The ratio of patients receiving retreatment indicates durable cosmetic effect, supported by a high satisfaction rate after treatment and a long duration of effect in a substantial rhinop,asty of patients.

Case 2—to straighten dorsal hump and increase tip definition. A, Profile view of a healthy year-old woman who had had an unknown permanent filler injected into the upper lip in another country and presented with an unfavorable result and a wish to address her profile view. She had no other relevant medical or surgical history. Augmentaion, Two weeks after an endoscopic forehead lift and simultaneous lower lip augmentation with 0. Case 6—to lengthen short nose. A, Profile view of a healthy year-old woman who wished to lengthen the nose.

As this was considered to be a difficult surgical procedure, the author decided to try to improve the length by HA injection. She had no relevant medical or surgical history. B, Improvement in nasal length after 2 years and 2 injections of Restylane Perlane total volume injected: The Filetupe was deposited intradermally with a sharp G needle in the distal end of the tip in the columella 0. Case 3—to smoothen postsurgical tip irregularities. A, Profile view of a year-old woman who rhinoplaaty with a poorly defined and underprojected tip after undergoing 2 previous rhinoplasties performed elsewhere.

B, Appearance 10 months after a successful closed rhinoplasty with triple conchal tip grafts. C, Four years after the tertiary surgery, the patient presented with increasing visibility of the tip grafts.

D, Appearance 2 years after intradermal injection of 0. Case 5—to increase tip definition, elevate low dorsum, and lower retracted alar rim. A, Profile view of a healthy year-old woman who presented with an underprojected tip and also wished to address the height of the dorsum and the retracted alar rim. The HA was deposited not only intradermally with a sharp G needle in all treated regions but also supraperiostally in the nasion. In addition to use for aesthetic purposes, the author has also injected HA gel to address functional nasal deficiencies.

See video, Supplemental Digital Content 2which shows functional nasal reshaping with asiaj injection of 0. Functional nasal reshaping; this video, Supplemental Digital Content 2, shows functional nasal reshaping with intranasal injection of 0. Long-term, less than one-third of all patients treated during to wished that the duration of effect would have been longer.

Case 4—to smoothen postsurgical tip irregularities. A, Two years after rhinoplasty in a year-old man; the patient came back wishing to address an increasing tip graft visibility that he had first started to notice during augmrntation past year. He had no other relevant medical or surgical history.