As this indication is gaining popularity in the aesthetic arena, one expert advises fellow surgeons to carefully choose the filler used and maintain an in-depth knowledge of the anatomy and physiology of the nose. These are key to achieving excellent aesthetic outcomes and avoiding complications, he says.
"I believe the best results of rhinoplasty can still be achieved with surgery. However, there are those cases where a nonsurgical approach using fillers can achieve immediate aesthetic results, and in some patients, fillers may be a solution for the aesthetic correction of a nose deformity," says Steven H. Dayan M.D., F.A.C.S., a facial plastic and reconstructive surgeon in Chicago.Many different fillers can be used in the nonsurgical procedure, including silicone, hyaluronic acid products such as Juvéderm (Allergan) and even autologous fat injections. However, according to Dr. Dayan, Radiesse (calcium hydroxylapatite, BioForm/Merz) and Restylane (hyaluronic acid, Medicis) are two of the best fillers for this indication.
A nonsurgical approach could be an option in a patient who is either apprehensive of surgery or where surgery is contraindicated due to financial or medical issues.
"Some patients may want a little correction of a small irregularity, but surgery may seem too much of a heroic effort for the cosmetic correction to be made. Fillers would be an option here and can be very effective when used sparingly and placed strategically," says Dr. Dayan, who recently spoke at the 6th Annual Facial Cosmetic Surgery meeting in Las Vegas.
INDICATIONS With sufficient volume injected just above the radix, Restylane or Radiesse can often be effective in correcting a large dorsal convexity of the nose, masking the deformity. In these patients, the nose often needs to be balanced, and by adding volume with a filler, a bigger nose can appear smaller and achieve an improved aesthetic proportion to the face. According to Dr. Dayan, the cosmetic correction can last approximately nine months to one year using either Radiesse or Restylane.
Another indication could be in patients with a near-miss rhinoplasty, where, according to the patient, the nose only has a slight imperfection to be corrected (such as a slight localized depression or other irregularity). Using 0.1 cc to 0.2 cc of either Restylane or Radiesse in these cases can result in cosmetic outcomes lasting three to four years.
"This longevity may not be entirely due to the filler itself but also due to the product's ability to induce neocollagenesis in the targeted area," Dr. Dayan says. "This can effectively fill out the depression or irregularity and mask the cosmetic flaw."
Nonsurgical rhinoplasty has its place and should only be performed in carefully selected patients. According to Dr. Dayan, the technique is too frequently chosen by surgeons who attempt to recreate the results of a surgical rhinoplasty. Doing so can result in many complications, including impending necrosis, necrosis and subsequent scarring, as well as hypersensitivity and infections.
If a physician gives too much filler or erroneously places it intravascularly, impending necrosis or frank necrosis can quickly occur. Infections can also be a common and serious complication following a nonsterile injection or too many injections, particularly in this region.