A nonsurgical rhinoplasty is a semi-permanent procedure that changes the shape of your nose with injections of high viscosity dermal filler. It can camouflage lumps, bumps and small defects, raise a flat bridge or drooping tip, or make a crooked nose look straighter and more symmetrical
The nose is the most prominent facial feature, particularly, on a profile view. The rise of the ‘selfie’ saw rhinoplasty as one of the most requested surgical procedures of the last decade.
A three-dimensional assessment (profile, frontal view) of the nasal skeleton is of paramount importance. Optimal results can only be achieved following a thorough evaluation of all the factors that are associated with the nasal appearance.
For instance, missing frontal teeth causing inversion of the lips and accentuation of the smoker’s lines or a retracted chin will keep distracting from facial balance even after a well corrected nasal dorsal asymmetry.
Other facial features affecting nasal appearance
You can achieve a better definition in a thin-skinned nose, but a thick skin is more forgiving to potential mistakes (e.g. poor injection technique, overcorrection), lumps and bumps formed following injection of a filler, etc.
The point at which the nasal septum merges, in the midsagittal plane, with the upper lip.
When viewed in profile, an under projected chin may magnify the perceived size of the nose, often treatment of the two together compliment the overall result.
Contour of lips and philtrum
Full lips and a well-defined philtrum improve the nasolabial angle.
Enhancement of the malar/mid-face volume makes the nose appear smaller.
The supporting skeleton of the nose is composed of bone and hyaline cartilage. The bony part of the nose consists of nasal bones, frontal processes of maxillae and nasal part of the frontal bone and its nasal spine. The cartilaginous part consists of five main cartilages: two lateral cartilages, two greater alar (or lower lateral) cartilages and a septal cartilage. The bony part is covered with periosteum, which is continuous with the perichondrium over the cartilaginous part.
It is very important to note that the angular branch of the facial artery runs along the nasolabial fold, branching off the superior labial artery . The alar branch is a terminal branch of the angular artery, which is the main feeding blood vessel for the nasal ala. The superior labial artery and the dorsal branch of the supratrochlear artery communicate with the alar branch around the nasal tip. The angular artery and vein cross the side of the nose as they approach the medial canthus. Bearing this image in mind can help practitioners to avoid injecting into these important blood vessels.
Nasal Arterial System
Injection techniques- for theoretical purpose online, this process is best observed during your practical training day.
For correcting humps, augmenting the bridge or defining the dorsum of the nose with HA filler such as Juvéderm Ultra 4. VOLUMA or Revolax Deep are great options and can also be used when greater volumes are required and in such as in cases of westernisation of a depressed bridge in an Asian nose.
By using a 27G/30g x 0.5inch sterile hypodermic needle (0.4x13mm) (usually starting on the bridge) inject a deposit, on average, anything between 0.2-0.5ml over the bridge of the nose depending on the degree of the augmentation you want to achieve.
REMEMBER: TO ASPIRATE at every injection point for 2/3 seconds
Use the same size needle to inject both the nasal dorsum and tip. Moving caudally, in a straight line connecting the glabella to the supratip, and by using a linear threading technique. Deposit threads of about 0.1-0.2ml per injection until the desired dorsal definition and augmentation has been achieved. Please note that by increasing the height of the dorsum, the nasofacial angle will decrease this will lead to an apparent decrease in nasal tip projection.
Therefore, you the refinement of the tip with pretty much every nose reshaping procedure is necessary.
Application of cold packs around the injection site which, in addition to instant pain relief, will also produce vasoconstriction, minimising any swelling or bleeding.
Tip lifting can be done as a stand-alone procedure – a ‘button tip’ or tinker bell tip is an increasingly requested procedure as clients look to soften and feminize nasal tip proportions.
Nasal tip techniques
Insert the needle through the columella and caudal aspect of the septal cartilage approximately 3-5mm below the tip defining points near the infratip break in a super anterior direction. Bearing in mind the columellar arteries, Inject boluses of 0.2-0.3ml between and over the domes as far as the suspensory ligament of the tip. The dome is formed by the junction between the middle and lateral crura of the greater alar cartilage. Ideally the projected tip of the nose should have a triangular appearance with its superior apex lying approximately 2 mm above the dorsum and this is what we try to recreate by injecting fillers in the dome area. This is a relatively safe area to inject as there are no end arteries other than anastomoses.
Cannula can be used to augment a nose; however, we believe the needle with aspiration to be the most superior method.