Injecting filler materials to augment the nose is demonstrating increasing safety and efficacy as a non-surgical alternative to rhinoplasty.
Although blindness and tissue necrosis have previously been reported in association with this approach, it is becoming more widely available, according to the author. He suggested that blindness, in fact, may occur, along with vascular injury.
Filler materials may be used as cartilage or camouflage grafts in rhinoplasty. Other uses include the straightening of a crooked nose; the camouflaging of dorsal humps; elevation and refinement of the nasal tip; fortification of nostrils; increasing the nasolabial angle; and improving a deep radix.
Hyaluronic acid and calcium hydroxyapatite are the two most commonly used fillers for these procedures, the author added. Clinicians are encouraged to have a deep understanding of the nasal anatomy before attempting this procedure.
A 30-gauge needle and aliquots not more than 0.1 mL are used for performing injections. They are placed in the correct plane and massaged into place, according to the author. He added that a slow and careful pace using a reflux maneuver on the syringe to place the injections medially is optimal. Needle insertions should be minimized. Over-injection of deep tissue could yield adverse outcomes including stretching of the skin and occlusion of the vasculature. Any bleeding may be controlled with pressure.
The author recommends following up with patients 2 weeks after the procedure. A 1-year improvement in nasal appearance is commonly reported. – by Rob Volansky
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