Nose reshaping with fillers

Today, classical surgical rhinoplasty is an advanced technique in the aesthetic and surgical correction of nasal deformities. However, surgeons observe a positive result from the operation only in 60% of cases. In the remaining 40%, complications or patient dissatisfaction with the aesthetic result appear. It's hard enough to fix this. That is why it makes sense to turn either to combined methods of correcting the shape of the nose, or to correction with fillers and botulinum toxin.

Dario Bertossi

MD, Plastic Surgeon, Associate Professor at the Faculty of Surgery at the University of Verona, internationally renowned for his innovations in surgical techniques, expert in advanced techniques in maxillofacial surgery. Actively involved in research and educational programs in maxillofacial surgery at the University of Verona, Italy.

Combining surgical techniques with other procedures that improve skin condition and texture is a positive trend. This approach is preferred in terms of safety, cost-effectiveness, lack of side effects, and rapid recovery. The combined use of tissue filling fillers with botulinum toxin injections is an important non-surgical resource that, in combination with other techniques, can significantly improve the results or prolong the effect of other procedures.

The clear advantage of the therapeutic approach is the absence of a rehabilitation period. Today, more than ever, patients are interested in non-invasive express procedures with a short recovery period. In addition, the use of therapeutic drugs not only changes the shape of the nose, but has a positive effect on the condition of the skin, preventing the formation of wrinkles on the back of the nose, which gives an additional anti-age effect. Hyaluronic acid is able to induce collagen formation and provide excellent aesthetic results in improving skin texture, eliminating dark circles under the eyes and correcting nasal deformities.

How to choose the right patients for nose correction with fillers?

Indications for this correction can be:

• sharp nose bridge
• nasal asymmetry
• cavities or bumps on the nose
• drooping or bifurcation of the tip of the nose
• change resulting from trauma or plastic surgery
• sagging skin and the appearance of "hare wrinkles"
• flat and wide bridge of the nose

Contraindications for dorsum correction can be:

• diseases of the endocrine system II and III severity (special attention should be paid to hypo- and hyperthyroidism, diabetes mellitus)
• oncological diseases
• autoimmune diseases
• blood clotting disorder
• keloid scars
• presence of implants or non-biodegradable fillers
• allergic reactions

Possible complications during the correction are short-term and long-term.

Short-term complications include pain, hyperemia, and swelling at the injection site. Also, frequent complications include hematomas in the area of ​​​​filler injection due to abundant nasal vascularization and correction errors, which will be associated with an incorrectly selected dose.

Long-term complications include: nasal embolism, gravitational descent of the tip of the nose, disruption of the shape of the nose, development of fibrosis at the injection site, the occurrence of delayed allergic reactions.

The aim of our study was to develop a nasal analysis method to create a treatment protocol and define injection sites. We performed a matrix analysis of the noses of 150 patients who received filler injections between January 2013 and December 2014. We also focused on the amount of the drug administered in different age groups of patients (under 30, 40-50 and older than 50), the occurrence of immediate and delayed side effects in the zygomatic, infraorbital, paranasal and submental areas, and the effectiveness of clinical analysis in achieving the goal of the study.

Correction technique

1. Before the correction, patients undergo a consultation with a dermatologist to identify contraindications.
2. The procedure was performed on an outpatient basis under local application anesthesia (Emla cream for 30-40 minutes)
3. Needles and cannulas were used for the procedure. When using cannulas, hematomas and swelling appeared less frequently than when using needles.
4. Fillers were injected strictly into pre-designated areas and in small quantities.
5. The procedure was considered completed only after the sensitivity of the skin in the area that was being corrected was restored.

Materials and methods

We excluded patients who reported allergies or chronic conditions. Juviderm Voluma TM Allergan was chosen for administration. Before the procedure, all patients signed consent forms. Next, the noses of the patients were subjected to matrix analysis during the evaluation of the treatment plan and before the introduction immediately after marking.

After comparing pre- and post-operative images, we noted the severity of the correction. Photo survey showed satisfactory results in 97% of cases, unsatisfactory - in 1.5%, overcorrection - in 1.5%. Matrix analysis of noses after the procedure showed a good result.

Conclusions

Perionasal fillers are excellent for correcting nasal defects and are an alternative for patients seeking non-surgical, safe, minimally invasive, and affordable methods. Therefore, every plastic surgeon must be fluent in this technique. Such knowledge will allow using the optimal amount of the drug to correct certain defects, achieve maximum effect and patient satisfaction.

The combination of botulinum toxin injection and fillers can also be combined with various laser or light techniques to create ablative and non-ablative skin rejuvenation techniques, improve skin surface, remove pigmentation, vascular changes, wrinkles, post-acne scars, skin lifting, wrinkle correction and age skin changes.

The guests of the XIV International Symposium on Aesthetic Medicine Mimi Ehrenreich, dermatocosmetologist, surgeon from France, told about the features of the "one puncture" technique and about the methods of face correction in her report "Modern trends in facial modeling from one point.  ;