The augmentation of soft tissue is achieved through a non-surgical or injection rhinoplasty using fillers like HA (hyaluronic acid). Fillers are injectable products which may aid in correcting nasal deformities and eliminate the significant time, cost and risk of complications associated with a surgical rhinoplasty. While the use of fillers only allows for limited and temporary augmentation, the results last for an average of 13.5 months1. A study1 that assessed the longevity, outcome and adverse effects of non-surgical rhinoplasties using degradable synthetic fillers, found the following when studying 46 patients:
- A total of 26 patients were injected with calcium hydroxyapatite (the main constituent of Radiesse® dermal fillers) with the other 20 receiving hyaluronic acid (the main constituent of Restylane® and Juvéderm® fillers) injections over a period of three years.
- The patients had comparative images taken and their level of satisfaction evaluated.
- Three weeks post-treatment, 85% of the patients noted that they were satisfied with their results. Nine months after treatment 87% of the patients said they were completely satisfied with their results, regardless of the filler that was used.
- The longevity of the treatment varied between six and 30 months with an average of 13.5 months.
- The study noted minimal complications, with the only complications (noted in three of the 26 patients) being related to the use of calcium hydroxyapatite which resolved after treatment.
- The research team concluded that biodegradable and injectable fillers are an effective means of correction for those with minor nasal irregularities or deformities.
- It was noted that doctors and aesthetic practitioners should pay special attention to the techniques used when injecting fillers as these play a role in the development of complications as well as the end result.
A non-surgical rhinoplasty inherently adds more volume to a patient’s nose. Considering that a large number of traditional (i.e. surgical) reduction rhinoplasties are performed in order to remove or refine any perceived imperfections so as to make the nose appear smaller, it is vital that patients are aware of this fact so that the NSR procedure and outcomes are clearly understood.
Although slight nasal irregularities can generally be treated safely, those considering a non-surgical rhinoplasty should ensure that their aesthetic practitioner is aware of the nature of the nasal regions blood supply, the anastomoses and short arteries that should all to be taken into consideration before undergoing NSR so as to avoid complications.
The accidental injection of a dermal filler into a blood vessel can result in a variety of serious and often permanent complications. Depending on the filler used, these can range from bruising, swelling, pain, scabs and scarring to abnormalities in vision, blindness and in severe cases, stroke. Education regarding nasal anatomy and experience in administering these types of treatments are key, which is why selecting a skilled practitioner is of the utmost importance.
What fillers are used in a non-surgical rhinoplasty?
The types of fillers that have been traditionally used for facial fillers include silicone, autologous fat, calcium hydroxyapatite and polytetrafluoroethylene. However, in recent years there have been advances in the development of HA (hyaluronic acid) fillers that are longer lasting and have structures that are more cohesive, making them one of the most commonly used products for non-surgical rhinoplasty2.
As a product, HA is malleable, has a low immunogenicity (i.e. the ability of a product to provoke an immune system response which forms part of the body’s natural defence system against harmful pathogens) and is more durable than other fillers. Furthermore, the effects of this filler can be reversed through the use of hyaluronidases – a group of enzymes that allow for the degradation (i.e. breakdown) of HA.
Calcium hydroxyapatite and collagen are also sometimes used by NSR practitioners however, the characteristics of these filers are different to those of HA. The reason for these specific fillers being favoured and used by some practitioners is due to their ability to form a more rigid and less malleable structure. The downside to this is that any complications that arise may be more difficult to correct. If any form of revision is necessary, these fillers will need to be removed and cannot be reversed by the simple injections of dissolving agents like hyaluronidase.
Who is the ideal candidate for a non-surgical rhinoplasty?
If you are considering having a non-surgical rhinoplasty done, then the below information outlines what this procedure is typically able to achieve:
- Nasal symmetry
- Smoothing and eradication of any minimal contour irregularities
- The filling of nasal tissue in order to smooth out bumps and their prominence
- Improving dents, grooves or depression on the nose
- Improving the appearance of a drooping tip
- Raising and defining a flattened bridge (i.e. the nasal dorsum)
- Diminishing the appearance of a rounded nose tip
- Improving the appearance of a saddle or crooked nose
Bear in mind that your plastic surgeon or aesthetic practitioner will discuss your options with you and outline what an NSR can realistically achieve in your specific case.
References:
1. NCBI. 2015. Injection Rhinoplasty with Hyaluronic Acid and Calcium Hydroxyapatite: A Retrospective Survey Investigating Outcome and Complication Rates. Available: https://www.ncbi.nlm.nih.gov/pubmed/26126227 [Accessed 13.04.2018]
2. NCBI. 2008. The science of hyaluronic acid dermal fillers. Available: https://www.ncbi.nlm.nih.gov/pubmed/18330796 [Accessed 13.04.2018]