Raj Kanodia: when is injection rhinoplasty relevant?

Raj Kanodia, a world-renowned plastic surgeon, talks about the art of non-surgical nose correction.

As a plastic surgeon, I work endonasally on all noses to ensure there is no columellar scar after surgery. However, in my experience with surgical rhinoplasty, some patients may be well suited for medical or injection rhinoplasty.

In the case of post-traumatic or saddle deformities, injections of hyaluronic acid can be administered. Also, such injections can be used in case of dents and depressions after rhinoplasty. Sometimes, despite all the efforts of the doctor, it is simply not possible to achieve an absolutely even surface of the nose. The main problem in this case is the recesses in the upper lateral areas of the cartilage. In this case, injections of hyaluronic acid – a great way to eliminate such imperfections.

Injection Rhinoplasty Precautions

Before performing any injections, the doctor must know the exact location of the arteries. However, whatever one may say, even if we know where this or that artery passes, the injection still has to be done blindly. Small blood vessels run along the periosteum and perichondrium, so I recommend inserting the needle at the base of the columella and dorsum. Also, before insertion, it is necessary to make sure that the needle or cannula does not enter the blood vessel.

The upper lateral cartilage is sometimes weakened. When performing rhinoplasty and working with bone and cartilage in order to remove the hump, it sometimes happens that the upper lateral cartilage loses its connection with the bone and immediately breaks out. This aesthetic deformity can also be corrected by injection.

Research and publications testify to at least rare, but still occurring cases of infections. Sterility – rule number one for preventing infections. Injections into closed places are very different from injections into the chin or cheek. If it is necessary to reinsert the needle after an injection, a different sterilized needle must be used.

To prevent infections, I cleanse the skin twice with Betadine and give patients antibiotics before and after the procedure.

Injection rhinoplasty for nose augmentation

Recently I had a patient with a small interbrow. The lower third of the nose looked more bulbous due to the poorly developed upper part. We injected hyaluronic acid into the back of the nose and created the best silhouette – the tip no longer looked so bulbous. This visual illusion can be created by enlarging the upper part of the back of the nose. To do this, you need to make a small entry point with a needle, then remove it and insert a cannula into the created point. I use cannula 25 – 40 caliber because it can be moved to any desired location while holding it with your finger. One of the main advantages of this medical augmentation is the speed of the procedure (only 10 minutes), the absence of the need to carry out the procedure intranasally using an implant.

Injections of hyaluronic acid will also help to avoid problems that arise during implant placement – their movement, protrusion and/or infection.

Sometimes patients want to go through a gradual increase. And here is injection rhinoplasty – great option. One of the risks of injection rhinoplasty is compression of the blood vessel if too much material is injected. Therefore, it must be ensured that an excessive amount of material is not used for hyaluronic acid injections, especially if it is thick. We often use half a cc of HA in one treatment.

Nasal dorsum augmentation can be performed intranasally (when the cannula is inserted from the inside). Compared to extranasal administration, intranasal administration allows you to direct the cannula at a more favorable angle and avoid anesthesia. The cannula is also more suitable for layering the product.

Possible complications of injection rhinoplasty and their prevention

When a nose is enlarged, all the blood vessels in the back of the nose are left unaffected because no surgery is performed. Even if one of the blood vessels is injured or compressed, the remaining vessels will function normally, so the blood flow to the skin will also be normal.

During rhinoplasty and removal of the skin from the back of the nose, there is a possibility of damage to one or more small arteries. If five small arteries pass through the back of the patient's nose, and two of them are damaged during the first surgical operation, he has only three functional arteries left. Therefore, collateral circulation and neovascularization may occur. The more operations the patient has undergone, the more careful the doctor must be when removing the needle.

The arteries of the dorsum of the nose are responsible for nourishing the skin, so damage to them will lead to necrosis. The more surgeries a patient has undergone, the more problems may arise.

It is also possible to combine surgical and injection rhinoplasty. Instead of injecting into the columella, we can create a pocket in the anterior nasal spine and use an augmentation implant. In rare cases, such implants can move and change, creating a certain asymmetry. In such cases, only a small increase in the area at the base of the columella is necessary. To increase and support the tip of the nose for 2 – We have been using Evaluna or Perlane for 3 years.

Of course, sometimes the only option for a patient is surgical rhinoplasty. Our main desire – help the patient in an aesthetically correct way, which is why the careful choice of the method used is so important for the success of the procedure.