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Santamaría-Gadea A, Sevil-Serrano C, Buendía Pérez J, Mariño-Sánchez F. Nonsurgical Rhinoplasty after Rhinoplasty: A Systematic Review of the Technique, Results, and Complications. Facial Plast Surg Aesthet Med 2024. [PMID: 39230478 DOI: 10.1089/fpsam.2024.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024] Open
Abstract
Introduction: Surgical rhinoplasty is a complex procedure with a high revision rate. Nonsurgical rhinoplasty (NSR) could avoid secondary rhinoplasty allowing the correction of postsurgical defects. A systematic review has been performed among adult patients who had previously undergone surgical rhinoplasty and now presenting for NSR with filler, demonstrated most common indications, fillers, and complications in this technique. Materials and Methods: A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) system guidelines. Primary outcomes included indications for NSR in patients with prior rhinoplasty and complication rate. Secondary outcomes included filler material and degree of patient satisfaction. Results: Twenty articles met the inclusion criteria, obtaining 2,048 patients analyzed in the review. Hyaluronic acid was the most used filler, found in 67% of patients. Indications were highly variable, considering deformities of the middle third of the nose the most remarkable. A high degree of satisfaction was found in the analyzed studies and the rate of major complications was low. Discussion and Conclusions: NSR in patients with prior rhinoplasty is a useful option for correcting a range from subtle aesthetic defects to severe nasal deformities. However, this technique is not exempt from complications, since an increased risk of skin necrosis has been observed.
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Affiliation(s)
- Alfonso Santamaría-Gadea
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Ramon y Cajal, Madrid, Spain
| | - Carlota Sevil-Serrano
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Ramon y Cajal, Madrid, Spain
| | - Javier Buendía Pérez
- Associate Professor Universidad Complutense de Madrid, Madrid, Spain
- Acting Chief, Plastic and Reconstructive Surgery Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Franklin Mariño-Sánchez
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Ramon y Cajal, Madrid, Spain
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Silikovich F, Kroumpouzos G. Nonsurgical Rhinoplasty: Results from a Retrospective Study of Rino-4-Puntos Technique with Hyaluronic Acid. Aesthetic Plast Surg 2024:10.1007/s00266-024-04263-z. [PMID: 39060796 DOI: 10.1007/s00266-024-04263-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Nonsurgical rhinoplasty (NSR) utilizing hyaluronic acid (HA) filler injections is increasingly used to address nose shape issues. While refinements have been proposed, the technique lacks standardization. OBJECTIVES Our study aimed to evaluate the aesthetic outcome, longevity of results, safety, and patient satisfaction with the novel Rino-4-Puntos (R4P) NSR technique. METHODS This is a retrospective study of consecutive individuals treated with R4P between January 2021 and July 2023. All participants had one of the four indications: rectification of the dorsum (21%), triangulation of the tip (32%), projection (25%), and strengthening of the columella (22%). Each patient received two hyaluronic acid (HA) fillers: one with intermediate G prime (G') at Points 1-3 and another with high G' at Point 4, which is further divided into Points 4.1, 4.2, 4.3, and 4.4. The injection points were as follows: P1 (radix, 0.05-0.15 mL, supraperiosteal), P2 (supratip, 0.025 mL, suprachondrial), P3 (tip, 0.15 mL, deep fat), P4 (columella, 0.30 mL, supraperiosteal [4.1], or deep fat [4.2, 4.3, and 4.4]). RESULTS Four hundred individuals (n = 284 [71%] females) are included. The mean filler volume used was 0.65 ± 0.17 mL. Injecting small boluses (≤ 0.05 mL) in the midline at deep planes minimized the risk of adverse effects, as no vascular complications occurred. Ninety-three percent of participants considered the overall outcome at least satisfactory ("good," "very good," or "excellent"). The treatment effect was maintained for a median of 11 months. CONCLUSIONS The R4P technique refines NSR by combining enhanced aesthetic outcome, longevity, and safety. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Fernando Silikovich
- Concepto 4 Puntos Clinic, Av Monroe 2270 1405, Belgrano, B1428, Buenos Aires, Argentina.
| | - George Kroumpouzos
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, RI, USA.
- GK Dermatology PC, 541 Main St, Suite 320, South Weymouth, MA, 02190, USA.
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Song D, Wang X, Yu Z. Nonsurgical Rhinoplasty: An Updated Systematic Review of Technique, Outcomes, Complications, and Its Treatments. Aesthetic Plast Surg 2024:10.1007/s00266-024-04161-4. [PMID: 38862661 DOI: 10.1007/s00266-024-04161-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/21/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND For patients looking for temporary results or who do not want surgery, nonsurgical rhinoplasty using filler injections has become increasingly popular. Filler materials and surgical techniques have improved in recent years, but serious complications remain. Therefore, the aim of this systematic review is to summarize the common types of fillers and injection techniques, complications, and treatment to help clinicians perform in a safer and more effective way. METHODS A systematic review was performed using keywords and Medical Subject Headings search terms. PubMed, Embase, and the Cochrane Library were searched using the appropriate search terms. Data collected from each study included injection materials, location, technique, patient satisfaction and complications, and treatment. RESULTS From the 1812 studies identified, 30 were included in the systematic review. A total of 9657 patients underwent nonsurgical rhinoplasty, most commonly with hyaluronic acid (HA) (96.76%), followed by calcium hydroxyapatite (CaHA) (1.22%). Overall satisfaction was 99.08%. The overall incidence of complications was 39.11%, with the highest incidence of erythema and swelling (27.95%). Most of the complications are mild, but there are still 0.27% of the patients who have undergone severe complication-an arterial occlusion. CONCLUSIONS Nonsurgical rhinoplasty is an effective and relatively safe option for improving the profile of the nose, with a short operative time and high patient satisfaction. Most of the complications were mild, but still serious vascular complications such as blindness, skin necrosis, and stroke were as high as 0.27%. A thorough understanding of the anatomy of the nasal vessels and a precise surgical technique is an important basis for prevention. A BULLET POINT LIST: (1) We summarize the common types of fillers and injection techniques, complications, and treatment of complications to guide physicians to perform nonsurgical rhinoplasty in a safer and more effective manner. (2) Out of 1812 studies through the search strategy, 30 articles were included in the systematic review. A total of 9657 patients underwent nonsurgical rhinoplasty. (3) Nonsurgical rhinoplasty is an effective and relatively safe option to improve the profile of the nose, with a short surgical time and high patient satisfaction. (4) Most of the complications were mild, but some severe complications due to the vascular factors such as blindness, skin necrosis, and cerebral infarction need to be vigilant. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Dandan Song
- Department of Plastic and Aesthetic(Burn) Surgery, The Second Xiangya Hospital, Central South University, No.139, Renmin Middle Road, Changsha, Hunan, People's Republic of China
| | - Xiancheng Wang
- Department of Plastic and Aesthetic(Burn) Surgery, The Second Xiangya Hospital, Central South University, No.139, Renmin Middle Road, Changsha, Hunan, People's Republic of China.
| | - Zidi Yu
- Department of Plastic and Aesthetic(Burn) Surgery, The Second Xiangya Hospital, Central South University, No.139, Renmin Middle Road, Changsha, Hunan, People's Republic of China
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Mortada H, Korb A, Mawdsley E, Suresh J, Xu J, Koorapaty P, Khajuria A. The Use of Hyaluronic Acid in Non-surgical Rhinoplasty: A Systematic Review of Complications, Clinical, and Patient-Reported Outcomes. Aesthetic Plast Surg 2024; 48:194-209. [PMID: 37217605 DOI: 10.1007/s00266-023-03386-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/26/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION In cosmetic practices, non-surgical rhinoplasty using filler injections has become increasingly common. Nevertheless, the outcome and overall complications have not been studied as a systematic review in the literature. This study provides a high-quality systematic review of studies reporting clinical and patient-reported outcomes following non-surgical rhinoplasty with hyaluronic acid (HA) to further guide practitioners. METHODS This systematic review was conducted in accordance with PRISMA guidelines and was registered in PROSPERO. The search was conducted using MEDLINE, EMBASE, and Cochrane. The literature retrieval was conducted by three independent reviewers, and the remaining articles were screened by two independent reviewers. The quality of included articles was assessed using the MINORS and methodological quality and synthesis of case series and case reports tools. RESULTS A total of 874 publications were found based on the search criteria. A total of 3928 patients were reviewed for this systematic review from 23 full-text articles. For non-surgical rhinoplasty, Juvéderm ultra was the most commonly used HA filler. The nasal tip was most commonly injected (13 studies), followed by the columella (12 studies). Nasal hump deformities are the most common reason for non-surgical rhinoplasty. All studies showed high patient satisfaction. Among all patients reviewed, eight developed major complications. CONCLUSION Non-surgical rhinoplasty performed with HA has minimal side effects and a short recovery period. Furthermore, non-surgical rhinoplasty with HA results in high satisfaction. To strengthen the presently available evidence, further well-designed RCTs are needed. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266.
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Affiliation(s)
- Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, Riyadh, Saudi Arabia.
- Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia.
| | - Alexa Korb
- University College London, Gower Street, London, WC1E 6BT, UK
| | - Edward Mawdsley
- University College London Hospitals, 235 Euston Road, London, UK
| | - Jonathan Suresh
- Center for Medical Education in English, Poznan University of Medical Sciences, Poznan, Poland
| | - Joshua Xu
- Sir Alexander Fleming Building, Imperial College Rd, London, SW7 2DD, UK
| | - Piyush Koorapaty
- Sir Alexander Fleming Building, Imperial College Rd, London, SW7 2DD, UK
| | - Ankur Khajuria
- Kellogg College, University of Oxford, Oxford, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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Eng J, Sivam SK. Repairing the Nose after Failed Minimally Invasive Procedures. Facial Plast Surg 2023; 39:654-659. [PMID: 37321261 DOI: 10.1055/a-2111-1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Minimally invasive nasal procedures can be aimed at treating both functional and cosmetic problems. These procedures include lateral nasal wall implants, dermal fillers, thread lifting, and radiofrequency ablation. Though increasingly popular, nasal surgeons have limited data to draw from when faced with operating in a nose that has been altered by these techniques. In this article, best practice recommendations are described based on the available data for each of the techniques.
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Affiliation(s)
- James Eng
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Sunthosh Kumar Sivam
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
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Song D, Yu M, Liu J, Xu W, Li J, Li B, Cao Y, Zhou G, Hua Y, Liu Y. Cartilage Regeneration Units Based on Hydrogel Microcarriers for Injectable Cartilage Regeneration in an Autologous Goat Model. ACS Biomater Sci Eng 2023; 9:4969-4979. [PMID: 37395578 DOI: 10.1021/acsbiomaterials.3c00434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Despite numerous studies on tissue-engineered injectable cartilage, it is still difficult to realize stable cartilage formation in preclinical large animal models because of suboptimal biocompatibility, which hinders further application in clinical settings. In this study, we proposed a novel concept of cartilage regeneration units (CRUs) based on hydrogel microcarriers for injectable cartilage regeneration in goats. To achieve this goal, hyaluronic acid (HA) was chosen as the microparticle to integrate gelatin (GT) chemical modification and a freeze-drying technology to create biocompatible and biodegradable HA-GT microcarriers with suitable mechanical strength, uniform particle size, a high swelling ratio, and cell adhesive ability. CRUs were then prepared by seeding goat autologous chondrocytes on the HA-GT microcarriers and culturing in vitro. Compared with traditional injectable cartilage methods, the proposed method forms relatively mature cartilage microtissue in vitro and improves the utilization rate of the culture space to facilitate nutrient exchange, which is necessary for mature and stable cartilage regeneration. Finally, these precultured CRUs were used to successfully regenerate mature cartilage in nude mice and in the nasal dorsum of autologous goats for cartilage filling. This study provides support for the future clinical application of injectable cartilage.
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Affiliation(s)
- Daiying Song
- Research Institute of Plastic Surgery, Weifang Medical University, Weifang 261000, China
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai 200001, China
- National Tissue Engineering Center of China, Shanghai 200001, China
| | - Mengyuan Yu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai 200001, China
- Institute of Regenerative Medicine and Orthopedics, Xinxiang Medical College, Zhongyuan Institute of Health, Xinxiang 453000, China
- National Tissue Engineering Center of China, Shanghai 200001, China
| | - Jingwen Liu
- Research Institute of Plastic Surgery, Weifang Medical University, Weifang 261000, China
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai 200001, China
- National Tissue Engineering Center of China, Shanghai 200001, China
| | - Wei Xu
- Department of Plastic Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266011, China
| | - Juncen Li
- Research Institute of Plastic Surgery, Weifang Medical University, Weifang 261000, China
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai 200001, China
- National Tissue Engineering Center of China, Shanghai 200001, China
| | - Baihui Li
- Research Institute of Plastic Surgery, Weifang Medical University, Weifang 261000, China
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai 200001, China
- National Tissue Engineering Center of China, Shanghai 200001, China
| | - Yilin Cao
- Research Institute of Plastic Surgery, Weifang Medical University, Weifang 261000, China
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai 200001, China
- National Tissue Engineering Center of China, Shanghai 200001, China
| | - Guangdong Zhou
- Research Institute of Plastic Surgery, Weifang Medical University, Weifang 261000, China
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai 200001, China
- Institute of Regenerative Medicine and Orthopedics, Xinxiang Medical College, Zhongyuan Institute of Health, Xinxiang 453000, China
- National Tissue Engineering Center of China, Shanghai 200001, China
| | - Yujie Hua
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai 200001, China
- Institute of Regenerative Medicine and Orthopedics, Xinxiang Medical College, Zhongyuan Institute of Health, Xinxiang 453000, China
- National Tissue Engineering Center of China, Shanghai 200001, China
| | - Yu Liu
- Research Institute of Plastic Surgery, Weifang Medical University, Weifang 261000, China
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai 200001, China
- National Tissue Engineering Center of China, Shanghai 200001, China
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Magacho-Vieira FN, Santana AP. Displacement of Hyaluronic Acid Dermal Filler Mimicking a Cutaneous Tumor: A Case Report. Clin Cosmet Investig Dermatol 2023; 16:197-201. [PMID: 36711075 PMCID: PMC9882410 DOI: 10.2147/ccid.s398014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/13/2023] [Indexed: 01/24/2023]
Abstract
There has been considerable growth in the number of cosmetic injectable procedures in recent years. Consequently, physicians in general are seeing a greater number of patients who have previously had cosmetic implants. These patients often fail to mention or do not admit to having had previous cosmetic procedures, conditions that should be noted in their medical histories. In this article, the authors report a rare case of hyaluronic acid filler displacement resulting from injection in the nasal radix region that had been administered 10 months prior, which the patient failed to mention. The filler migration mimicked facial tumors, entangling an otherwise easy case and it was only recognized with the use of dermatological ultrasound. This serves as a warning and a reminder to include complications from cosmetic procedures in diagnostic hypotheses. Physicians need to be vigilant, question their patients' medical histories, and be familiar with diagnostic imaging options. The presence of dermal fillers should always be considered in cutaneous tumor lesions, since they can last for months to years, or be present in locations distant from the site of application.
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Affiliation(s)
- Fabiano Nadson Magacho-Vieira
- Magacho Institute for Health Education, Fortaleza, CE, Brazil,Department of Clinical, Aesthetic and Surgical Dermatology, Batista Memorial Hospital, Fortaleza, CE, Brazil,Correspondence: Fabiano Nadson Magacho-Vieira, Clínica Magacho - Avenida Desembargador Moreira, 1300, Sala 1419 - Torre Norte, Fortaleza, CE, 60170-002, Brasil, Tel/Fax +55 85 3246 0829, Email
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Consensus Recommendations on the Use of Hyaluronic Acid-Based Fillers for Nonsurgical Nasal Augmentation in Asian Patients. Plast Reconstr Surg 2022; 149:384-394. [PMID: 35077414 DOI: 10.1097/prs.0000000000008722] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Nonsurgical nasal augmentation using dermal fillers such as hyaluronic acid is increasing in popularity because of its less invasive nature and shorter downtime compared with traditional surgery. However, the complexity of the nasal vasculature makes it a high-risk procedure without proper training. Appropriate patient and product selection and safer standardized injection techniques are warranted to minimize complications and to achieve reproducible aesthetic results. In this article, recommendations for nonsurgical nasal augmentation using hyaluronic acid fillers are outlined, with focus on the dorsum, tip, and columella. METHODS A consensus meeting was conducted to develop recommendations on nonsurgical nasal augmentation in Asian patients using hyaluronic acid-based fillers. Literature review was performed using PubMed and Google Scholar. Relevant studies were included to formulate recommendations. Consensus statements were graded using the criteria outlined by the Grading of Recommendations Assessment, Development and Evaluation Working Group. RESULTS Nonsurgical nasal augmentation is an advanced procedure that warrants in-depth knowledge of the nasal anatomy. The panel recommends thorough preinjection assessment and counseling to fully align the patient's expectations with aesthetic goals. Injections must be deep and at the level of the periosteum or perichondrium to minimize risk of intravascular injection. Aliquots of hyaluronic acid must be introduced using slow, low-pressure, and low-volume injections. Optimal aesthetic effect is achieved with hyaluronic acid dermal fillers that are highly elastic, cohesive, and with good adaptability to their environment. CONCLUSIONS Hyaluronic acid injections are safe and effective in nonsurgical nasal augmentation. In-depth knowledge of vascular anatomy and proper injection techniques using suitable products are necessary to achieve aesthetic goals safely. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Radulesco T, De Bonnecaze G, Penicaud M, Dessi P, Michel J. Patient Satisfaction After Non-surgical Rhinoplasty Using Hyaluronic Acid: A Literature Review. Aesthetic Plast Surg 2021; 45:2896-2901. [PMID: 33660013 DOI: 10.1007/s00266-021-02182-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Few studies have focused on assessing patient satisfaction after non-surgical rhinoplasty using hyaluronic acid (HA). The main objective of this study was to perform a systematic review assessing patient satisfaction after non-surgical rhinoplasty using HA. METHODS We conducted a systematic review using the PRISMA model. All articles assessing patient satisfaction using self-questionnaires or scales (visual analogic scales, Likert scale) after non-surgical rhinoplasty were included. We also analyzed injection protocols and complications. The criteria for considering studies for the review were based on the population, intervention, comparison, outcome, timing and setting (PICOTS) framework. RESULTS A total of 674 patients were included in eight studies. Mean age was 29.5 years old (min = 19, max = 67, sex ratio = 0.20). Rates of "satisfied" or "very satisfied" patients were 100% immediately after injection (n = 404/404 patients), 98.2% in the weeks following injection (n = 628/639 patients), 84.7% 3 months after injection (n = 333/393 patients) and 96.4% one year after injection (n = 60/62 patients). Duration of HA effectiveness ranged between 8 and 14 months. One local infection (0.001%) but no skin necrosis and no blindness were reported. Most of authors used less than 1 mL of HA per procedure. CONCLUSIONS Provided precautions for use and indications are observed, and presuming good anatomical knowledge, non-surgical rhinoplasty is an interesting procedure associated with high satisfaction rates. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Thomas Radulesco
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, APHM, La Conception University Hospital, 147 Bd Baille, 13385, Marseille Cedex, France.
- IUSTI, Aix-Marseille University, 13385, Marseille Cedex, France.
| | - Guillaume De Bonnecaze
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, CHU Toulouse, Toulouse, France
| | - Martin Penicaud
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, APHM, La Conception University Hospital, 147 Bd Baille, 13385, Marseille Cedex, France
| | - Patrick Dessi
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, APHM, La Conception University Hospital, 147 Bd Baille, 13385, Marseille Cedex, France
| | - Justin Michel
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, APHM, La Conception University Hospital, 147 Bd Baille, 13385, Marseille Cedex, France
- IUSTI, Aix-Marseille University, 13385, Marseille Cedex, France
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Dual-Plane Injection Technique With Microscale Tumescent Solution for Asian Rhinoplasty. Dermatol Surg 2021; 47:1015-1016. [PMID: 34167134 DOI: 10.1097/dss.0000000000002798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moon HJ, Lee W, Do Kim H, Lee IH, Kim SW. Doppler Ultrasonographic Anatomy of the Midline Nasal Dorsum. Aesthetic Plast Surg 2021; 45:1178-1183. [PMID: 33140196 DOI: 10.1007/s00266-020-02025-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 10/18/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study was performed to identify a safe method for filler injection to prevent blood vessel damage, by means of checking the location and depth of the blood vessels on the midline of the nose using Doppler ultrasonographic imaging. METHODS Ultrasonographic images of the nasal areas of patients for filler injection rhinoplasty were reviewed. The location and depth of the dorsal nasal arteries and the intercanthal vein in each part on the midline of the nose were checked. RESULTS The intercanthal vein was detected in the midline of the radix in 22 patients and the midline of the rhinion region in two patients. There were no patients in whom the intercanthal vein was observed in the midline of the supratip region. The dorsal nasal artery was detected in the rhinion region in six patients and in the supratip region in two patients. There were no patients in whom the dorsal nasal artery was observed in the midline of the radix. The dorsal nasal artery was located within 1.2 mm from the perichondrium or periosteum in three patients in whom it was detected in the rhinion. CONCLUSIONS When performing dorsal augmentation, the injection of filler into the preperiosteal layer in the rhinion region should be avoided for the prevention of vascular embolism. During dorsal augmentation in patients with a nasal hump, the filler can be injected into the preperiosteal space in the radix by introducing a needle perpendicular to the periosteum from the skin. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
| | - Won Lee
- Yonsei E1 Plastic Surgery Clinic, Anyang, South Korea
| | - Hyun Do Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 06591, Korea
| | - Il Hwan Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 06591, Korea
| | - Soo Whan Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 06591, Korea.
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Rhinoplasty With Hyaluronic Acid: A Standard 5-step Injection Procedure Using Sharp Needle. Ann Plast Surg 2021; 85:595-600. [PMID: 32756257 DOI: 10.1097/sap.0000000000002516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To explore the clinical effect of rhinoplasty with a standard 5-step injection procedure of hyaluronic acid using sharp needle in correction of deficient features of the Chinese nose. METHODS Between January 2016 and December 2018, hyaluronic acid was injected with the sharp needle by a standard procedure in the anterior nasal spine, nasal columella, nasal tip, nasal root, and dorsum, as well as the junction region of nasal root and brow in 198 Chinese patients. The postoperative curative effect was analyzed, and the adverse reactions were observed. RESULTS The nasal shape in all patients was significantly improved, obtaining the stereoscopic appearance, and satisfactory results. During a 6-month follow-up, 4 patients developed local subcutaneous congestion and bruising in the nasal dorsum after treatment, which disappeared within 2 weeks. No patients suffered from complications such as infection, embolism, necrosis, transparent nasal dorsum, and widened nasal roots. CONCLUSIONS Injection of hyaluronic acid with the sharp needle by a standard 5-step procedure is a safe technique that can effectively correct the deficient features of the Chinese nose.
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Kumar V, Jain A, Atre S, Shome D, Kapoor R, Doshi K, Vadera S. Non-surgical rhinoplasty using hyaluronic acid dermal fillers: A systematic review. J Cosmet Dermatol 2021; 20:2414-2424. [PMID: 33900020 DOI: 10.1111/jocd.14173] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Non-surgical rhinoplasty using hyaluronic acid dermal fillers is a cosmetic procedure that has been becoming increasingly popular among patients wanting to correct nasal deformities or nasal irregularities, in the recent years. AIM This systematic review aims to provide quality evidence about the success of non-surgical rhinoplasty procedures in terms of patient satisfaction and complications. METHODS A systematic electronic literature search using keywords and MESH search terms over the PubMed/Medline, Cochrane Central, Scopus, and EBSCO online databases was conducted from November 2005 to February 2021. Additionally, the reference lists of included systematic reviews were hand searched. Data collected included patient satisfaction and complications from prospective and experimental studies providing highest level of evidence. Articles were critically appraised, and MINORS scale was used to assess the risk of bias. RESULTS Based on the search criteria, 2896 citations were found. After removing duplicates and screening for relevance, 23 citations were finalized for full-text review, of which 12 articles were excluded and 11 articles were included in the study. The average satisfaction of patients amongst the studies was found to be >90%. In all the studies, transient edema and erythema, post-injection pain, and bruising were some temporary complications. Rare complications that were reported were vascular impairments and hematoma. CONCLUSIONS Non-surgical rhinoplasty is a good, minimally invasive alternative over conventional rhinoplasty. There is however a paucity of quality data in the form of experimental and prospective studies regarding the accuracy, effectiveness, and complications of non-surgical rhinoplasty.
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Affiliation(s)
- Vaibhav Kumar
- The Esthetic Clinics, Mumbai, India.,Department of Public Health Dentistry, Terna Dental College, Navi Mumbai, India
| | - Anuj Jain
- Craniomaxillofacial Surgeon & Implantologist, Nagpur, India
| | | | - Debraj Shome
- Department of Facial Plastic & Facial Cosmetic Surgery, The Esthetic Clinics, Mumbai, India
| | - Rinky Kapoor
- Department of Dermatology, Cosmetic Dermatology & Dermato-Surgery, The Esthetic Clinics, Mumbai, India
| | - Komal Doshi
- Department of Facial Plastic & Facial Cosmetic Surgery, The Esthetic Clinics, Mumbai, India
| | - Sapna Vadera
- Department of Facial Plastic & Facial Cosmetic Surgery, The Esthetic Clinics, Mumbai, India
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Nonsurgical Rhinoplasty: A Systematic Review of Technique, Outcomes, and Complications. Plast Reconstr Surg 2020; 146:41-51. [DOI: 10.1097/prs.0000000000006892] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Use of injectables in rhinoplasty retouching: Towards an evolution of surgical strategy? Literature review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:550-555. [PMID: 32205302 DOI: 10.1016/j.jormas.2020.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/13/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Surgical revision rate of rhinoplasty is from 5% to 15% in literature. OBJECTIVE OF REVIEW In the context of post-rhinoplasty deformities, we aim to investigate the modalities of using injectables, their impacts on revision rate of rhinoplasty as well as their influences on the surgical strategy. TYPE OF REVIEW We realized an international literature review to collect informations on main studies reporting series of exclusive secondary medical rhinoplasties or mixed primary/secondary medical rhinoplasties, as well as per-operative injection. SEARCH STRATEGY The databases of the National Library of Medicine, Cochrane Library, Embase and Web of science were explored using the following Boolean string: (rhinoplasty OR nose) AND (injectable OR fillers OR hyaluronic acid OR calcium hydroxylapatite). The search was limited to the English language literature for studies published from 2007 up to December 2019. RESULTS Fifteen cohort studies were included. Hyaluronic acid was the most commonly used injectable for rhinoplasty revision. Patient satisfaction rates varied between 80% and 100%. Reinjections were necessary in about 20 to 50% of cases whatever the used injectables. Minor complications (swelling, bruising, erythema) were frequent after filler injections (4%). Severe complications such granulomas or vascular embolism causing skin necrosis/visual impairment were rare (0.4%). Their physiopathology, management and prevention are detailed. CONCLUSIONS The use of injectables seems to reduce the need of secondary surgical rhinoplasties. It can be expected that an evolution in surgical practices will result from injectables using, but it will be possible only if the technique is perfectly understood to avoid potentially serious vascular complications.
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Both the Filler Amount and Columellar Elasticity Are Important in Injection Rhinoplasty in the Columella. Dermatol Surg 2020; 45:1339-1342. [PMID: 30516582 DOI: 10.1097/dss.0000000000001692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Xiong Z, Jiang Z, Liu K. Midline Volume Filler Injection for Facial Rejuvenation and Contouring in Asians. Aesthetic Plast Surg 2019; 43:1624-1634. [PMID: 31531699 DOI: 10.1007/s00266-019-01498-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/31/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hyaluronic acid (HA) injection is popular in cosmetic surgery because of its minimal invasion and immediate recovery. However, few injection techniques are specifically designed for Asians, considering their aesthetic and structural differences from those of Caucasians. METHODS The midline volume injection technique was performed on 37 Asian females and 3 males at sites including the forehead, glabella, nasal dorsum, nasal base and chin. The treatment focused on improving the facial profile projection. 3D image data were collected, and facial aesthetic angles were calculated. Volume changes in facial parts were analyzed before injection and during follow-up. Patient satisfaction was assessed using the visual analog scale (VAS). RESULTS The average injected filler volume was 6.14 ± 2.82 ml. The treatment optimized the facial contour and produced instant facial rejuvenation. On 3D images, the average midline volume increased by 6.02 ± 2.23 ml. An average volume decrease of 3.92 ± 1.94 ml was observed in the cheeks and was positively related to the increased midline volume. The average nasolabial and nasal facial angles were increased from 100.00 ± 7.37° to 107.93 ± 9.01° and 28.78 ± 3.28° to 31.78 ± 2.97°, while the mentolabial angle was decreased from 146.55 ± 7.83° to 141.13 ± 6.23°. The mean VAS scores were 2.28 ± 1.27 immediately after injection and 2.56 ± 1.20 after 6 months. CONCLUSIONS The midline volume injection technique of HA fillers is suitable for Asians. It greatly enhances the facial profile, as illustrated by volume changes in 3D images, leading to a more attractive facial appearance. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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18
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The cadaveric feasibility study of using filler augmentation at the lower nose for the reinforcement of the external nasal valve. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-017-1326-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Chen Q, Passos A, Balabani S, Chivu A, Zhao S, Azevedo HS, Butler P, Song W. Semi-interpenetrating network hyaluronic acid microgel delivery systems in micro-flow. J Colloid Interface Sci 2018; 519:174-185. [PMID: 29494879 DOI: 10.1016/j.jcis.2018.02.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/15/2018] [Accepted: 02/15/2018] [Indexed: 01/05/2023]
Abstract
Macroscopic hydrogels are commonly used as injectable scaffolds or fillers, however they may easily obstruct blood vessels, which poses risks and limits their clinical use. In the present study, three types of hyaluronic acid (HA)-based hydrogel micro-particles with non-covalent, covalent semi-interpenetrating and conventional 3D molecular networks, have been designed, fabricated and characterized. The micro-particles are spherical, biconcave or irregular in shape and their diameter ranged between 2.5 and 3.5 µm; their suspensions exhibit a tuneable viscosity, shear-thinning behaviour, dynamic stability and dispersity in microfluidic flow as a result of their specific particulate nature, providing thus a well-controlled injectable platform. Hydrogel particle suspensions also demonstrate an enhanced safety profile, in terms of the dispersity, cell safety, and hemocompatibility. In addition, Rhodamine 6G has successfully been loaded and released from the particles as a model for drug delivery. Functionalisation of hydrogel microparticles using synthetic polymers has been proven to be a cost-effective way to achieve desirable rheological properties and flow dynamic stability with improved physicochemical properties and biocompatibility in vitro, showing promise as a multifunctional biomedical material for various advanced surgical devices and therapies.
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Affiliation(s)
- Qiqing Chen
- Plastic Surgery Department, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China; UCL Centre for Nanotechnology and Regenerative Medicine, Division of Surgery & Interventional Science, University College London, London NW3 2PF, United Kingdom
| | - Andreas Passos
- Department of Mechanical Engineering, University College London, London NW1 2PS, United Kingdom
| | - Stavroula Balabani
- Department of Mechanical Engineering, University College London, London NW1 2PS, United Kingdom
| | - Alexandru Chivu
- UCL Centre for Nanotechnology and Regenerative Medicine, Division of Surgery & Interventional Science, University College London, London NW3 2PF, United Kingdom
| | - Shudong Zhao
- UCL Centre for Nanotechnology and Regenerative Medicine, Division of Surgery & Interventional Science, University College London, London NW3 2PF, United Kingdom
| | - Helena S Azevedo
- School of Engineering and Materials Science, Queen Mary, University of London, Mile End Road, London E1 4NS, UK
| | - Peter Butler
- Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, London NW3 2PF, United Kingdom
| | - Wenhui Song
- UCL Centre for Nanotechnology and Regenerative Medicine, Division of Surgery & Interventional Science, University College London, London NW3 2PF, United Kingdom.
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Abstract
PURPOSE OF REVIEW The use of injectable fillers for nonsurgical rhinoplasty has increased tremendously over the past decade. This review describes the most commonly used fillers and their indications in the context of recent reports of both their successes and failures. RECENT FINDINGS Hyaluronic acid and calcium hydroxylapatite are the two most commonly used fillers for injection. Recent studies have found that most injectable fillers are met with success and patient satisfaction, but vascular complications are still a serious problem of which physicians should be wary. SUMMARY Injectable fillers should continue to be considered for patients on a case-by-case basis, but physicians should be knowledgeable of the various filler types, their indications, and injection technique to prevent serious complications.
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Thomas WW, Bucky L, Friedman O. Injectables in the Nose: Facts and Controversies. Facial Plast Surg Clin North Am 2017; 24:379-89. [PMID: 27400851 DOI: 10.1016/j.fsc.2016.03.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Nasal injectables and surface treatments alter the appearance of the nose both primarily and following nasal surgery. Fillers such as hyaluronic acids, calcium hydroxyapatite, and fat have a variety of advantages and disadvantages in eliminating small asymmetries postrhinoplasty. All nasal injectables have rare but severe ocular and cerebral ischemic complications. The injection of steroids following nasal reconstruction has a role in preventing supratip swelling and can improve the appearance of grafts to the nose. Resurfacing techniques reduce the appearance of autotransplanted grafts to the nose; there is little controversy about their benefit but surgeon preference for timing is varied.
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Affiliation(s)
- William Walsh Thomas
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Lou Bucky
- Division of Plastic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Oren Friedman
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Tansatit T, Apinuntrum P, Phetudom T. Facing the Worst Risk: Confronting the Dorsal Nasal Artery, Implication for Non-surgical Procedures of Nasal Augmentation. Aesthetic Plast Surg 2017; 41:191-198. [PMID: 28032167 DOI: 10.1007/s00266-016-0756-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/28/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The nose is a dangerous site for filler injection. This study investigated the anatomy of the dorsal nasal artery at the upper part of the nose to clarify how ocular complications occur. METHODS Dissections were performed in 50 noses of the embalmed cadavers. Either the soft embalming or formaldehyde embalming processes were used. RESULTS The dorsal nasal artery is not a constant artery. The artery traveled in the subcutaneous tissue layer of the nasal dorsum on the transverse nasalis muscle and its midline nasal aponeurosis which connected the muscles on both sides. Bilateral dorsal nasal arteries existed only in 34%. In 28% of the specimens, a single and large dorsal nasal artery was presented. The diameter was 0.4 ± 0.2 mm when bilateral dorsal nasal arteries were present and 0.7 ± 0.3 mm in a single artery. The largest artery was 1.2 mm. The artery usually crossed the midline at the middle third part of the nose over the upper lateral cartilages to form an anastomosis with the contralateral lateral nasal artery as the oblique nasal artery in 14%. The artery might descend and communicate with the ipsilateral lateral nasal artery in 6% or descended as a midline artery and form the nasal tip plexus in 8%. In 38% of the specimens, the arteries became small, formed a subcutaneous plexus and randomly distributed on the superficial layer of the subcutaneous tissue in the upper two-thirds of the nose. CONCLUSION During the injections at the upper (bony) and middle (cartilaginous) part of the nose for nasal dorsal augmentation, the injector has to make sure the cannula tip is in the preperiosteal plane by reinsertion of the cannula if needed, due to the chance of encountering the large single dorsal nasal artery at the midline. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Tanvaa Tansatit
- The Chula Soft Cadaver Surgical Training Center and Department of Anatomy, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
| | - Prawit Apinuntrum
- The Chula Soft Cadaver Surgical Training Center and Department of Anatomy, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
| | - Thavorn Phetudom
- The Chula Soft Cadaver Surgical Training Center and Department of Anatomy, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
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Serious Vascular Complications after Nonsurgical Rhinoplasty: A Case Report. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e683. [PMID: 27200245 PMCID: PMC4859242 DOI: 10.1097/gox.0000000000000668] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 02/16/2016] [Indexed: 11/25/2022]
Abstract
There has been an increased global demand for dermal filler injections in recent years. Although hyaluronic acid-based dermal fillers generally have a good safety profile, serious vascular complications have been reported. Here we present a typical case of skin necrosis following a nonsurgical rhinoplasty using hyaluronic acid filler. Despite various rescuing managements, unsightly superficial scars were left. It is critical for plastic surgeons and dermatologists to be familiar with the vascular anatomy and the staging of vascular complications. Any patients suspected to experience a vascular complication should receive early management under close monitoring. Meanwhile, the potentially devastating outcome caused by illegal practice calls for stricter regulations and law enforcement.
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Safe Planes for Injection Rhinoplasty: A Histological Analysis of Midline Longitudinal Sections of the Asian Nose. Aesthetic Plast Surg 2016; 40:236-44. [PMID: 26893278 DOI: 10.1007/s00266-016-0621-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Dorsal nasal augmentation is an essential part of injection rhinoplasty on the Asian nose. Aesthetic physicians require detailed knowledge of the nasal anatomy to accurately and safely inject filler. METHODS One hundred and thirty-five histological cross sections were examined from 45 longitudinal strips of soft tissue harvested from the midline of the nose, beginning from the glabella to the nasal tip. Muscles and nasal cartilage were used as landmarks for vascular identification. RESULTS At the nasal tip, a midline longitudinal columellar artery with a diameter of 0.21 ± 0.09 mm was noted in 14 cadavers (31.1 %). At the infratip, subcutaneous tissue contained cavernous tissue similar to that of the nasal mucosa. The feeding arteries of these dilated veins formed arteriovenous shunts, into which retrograde injection of filler may be possible. All of the nasal arteries present were identified as subcutaneous arteries. They coursed mainly in the superficial layer of the subcutaneous tissues, with smaller branches forming subdermal plexuses. A substantial arterial anastomosis occurred at the supratip region, in which the artery lay in the middle of the subcutaneous tissue at the level of the major alar cartilages. These arteries had a diameter ranging between 0.4 and 0.9 mm and were found in 29 of 45 specimens (64.4 %). This was at the level midway between the rhinion above the supratip and the infratip. This anastomotic artery also crossed the midline at the rhinion superficial to the origin of the procerus on the lower end of the nasal bone. Here the arterial diameter ranged between 0.1 and 0.3 mm, which was not large enough to cause arterial emboli. Fascicular cross sections of the nasalis muscle directly covered the entire upper lateral cartilage. The subdermal tissue contained few layers of fat cells along with the occasional small artery. The procerus arose from the nasal bone and was continuous with the nasalis in 16 cadavers (35.6 %). There was fatty areolar tissue between the procerus and the periosteal layer and no significant arteries present. The procerus ascended beyond the brow to insert into the frontalis muscle with very few cutaneous insertions. The supratrochlear vessels and accompanying nerve were occasionally found on the surface of the frontalis muscle. CONCLUSION Most nasal arteries found in the midline are subcutaneous arteries. Filler should be injected deeply to avoid vascular injury leading to compromised perfusion at the dorsum or filler emboli at the nasal tip. LEVEL OF EVIDENCE V This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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