Non-surgical rhinoplasty (fillers in rhinoplasty)



9500 rub. — Laser peeling of the entire face for + plasma lifting as a gift

5500 rub. — Laser eyelid rejuvenation

4500 rub. — Remove crow's feet

Free – Preliminary inspection 15 min.

Sign up for a free inspection

Preliminary inspection 15 min. — free, registration is required — provide your phone number and contacts

Rhinoplasty, what is it?

Rhinoplasty - changing the shape of the nose. The intervention can be purely aesthetic, that is, work with the external, visible part - correcting the hump, narrowing, raising the tip of the nose. Or maybe for medical reasons, that is, in addition to correcting the shape, also restoring full nasal breathing.

Nose contouring with hyaluronic acid filler

Just a few years ago it was difficult to imagine that anyone other than a surgeon could correct and improve the shape of the nose. Surgical rhinoplasty is a rather complex operation that requires long-term rehabilitation. Of course, for people with impaired nasal breathing or the need for global changes in the shape and size of the nose, this is in any case an inevitable option. But for those who need only external improvements and, in comparison, very insignificant ones, they always wanted a softer version of the correction. And for this it is not enough to watch a cosmetologist’s blog on the topic of facial cleansing. Here the thing is much more serious in all respects. We are changing our face!

Nose correction with hyaluronic acid is a method that helps correct several features on the nose without surgery:

• smooth out or eliminate a hump
• smooth or eliminate nasal asymmetry
• raise the tip of the nose
• straighten the shape of the nose after injuries, surgeries

Before the procedure, the doctor conducts a consultation and examination to determine whether contour plastic surgery will give the expected result and find out the presence of possible contraindications.

Exercises, braces, massage and splints

Exercises, various fixatives and massage can be combined into a single group of methods for changing the shape of the nose, which can be used at home. Such techniques have become very popular recently. They are actively advertised on the Internet, and every year there are more and more people wanting to test their effectiveness through their own experience.

Popular gymnastics for facial muscles is the Carol Maggio method. The exercises should be performed every day for a long time (from several months to six months). The promised effect is a reduction in the size of the nose, improvement of the contours and projection of the tip. As practice shows, even strict adherence to the recommendations of the author of this technique does not bring the desired result.

New methods of non-surgical rhinoplasty include the use of various fixators: clips, clamps or splints. According to the instructions, the splint should be worn every day for 15-20 minutes, up to half an hour. If you follow the instructions for six months, you can achieve the desired changes.

According to reviews from people who decided to test the effectiveness of the method, a “session” of using a splint or other fixatives is accompanied by severe discomfort. Due to the pressure on soft tissues, the splint causes pain. Nasal breathing is difficult or impossible. Certain aesthetic inconveniences are associated with marks on the skin that remain after wearing the retainer. And, most importantly, such sacrifices ultimately do not give the desired result.

An equally unscientific method is to model the shape of the nose and correct defects using massage. Massage for nose surgery is ineffective and useless. It should be noted that all of the listed methods have nothing to do with official medicine. No one has ever tried to prove their effectiveness. The bet is on consumer trust and aggressive advertising, and the bet is justified, despite the complete failure of the proposed methods.

Why are people interested in rhinoplasty without surgery?

The answer is obvious. I would like to fix the existing problem. Some people do not like the relief of the nose in the form of a hump or drooping tip of the nose. At the same time, I don’t want to take additional risks when doing surgery. Rhinoplasty is a complex operation, and not every surgeon, even a plastic one, undertakes it. This is far from blepharoplasty. Rhinoplasty involves anesthesia and a serious rehabilitation period, which is painful and long.

The biggest disadvantage of surgical rhinoplasty is that
you can’t return it to how it was!
That is, if suddenly you don’t like something! The shape of the nose is not the same, something went wrong... then you will have to undergo another operation.

Along with the advent of fillers, it became possible to correct the nose with gel (based on hyaluronic acid). Anamnesis is collected, indications and contraindications are clarified.

I'm taking pain relief. Within 15 minutes I correct the nose and the person leaves with a new nose . Of course, the demand for such a procedure gradually began to go off scale and this is normal.

VIDEO - Why are people interested in rhinoplasty without surgery?

Pros and cons of the method

If you compare injection correction with plastic surgery, the first advantage that catches your eye is the non-surgical elimination of the defect, but it is not the only one.

• Fast results that can be seen immediately are also a clear advantage
• Highly effective in eliminating certain defects
• There is no recovery period and few contraindications (these include pregnancy and lactation, oncology, exacerbation of autoimmune diseases, allergies to the drug, viral infections and a tendency to form keloid scars)
• Affordable price

But there are also disadvantages that slightly limit the possibilities of correction. For example, if you want to make the tip of your nose sharper, fillers will not help you with this. You won't be able to radically change the shape of your nose. A delicate correction is available, the effect of which must be maintained by repeating the procedure once a year.

How to fix your nose without surgery

There are nuances when a person has a broken nose, when nasal breathing is impaired. This affects his health, but the cosmetologist cannot do anything here. And if you need to correct external signs, for example, some kind of depression on the nose, a hump, or raise the tip of the nose, then you can improve it very significantly without resorting to the help of a surgeon.

In my practice, there were situations when girls came from surgeons.

The surgeon told them: “Don’t bother, go to a cosmetologist and fix everything that you don’t like!”

The surgeon understands that what needs to be fixed is not worth the risks involved in the operation.

The procedure for non-surgical rhinoplasty is in demand and a very common question that arises during the procedure of rhinoplasty with injections: “How is it that you add volume with a drug, but the lips increase, which means the nose should increase, as well as the lips and cheekbones?

In fact, the nose visually shrinks because we add the drug at secret points, thanks to which the profile of the nose becomes neater, the nose becomes more upturned and the hump that visually enlarged the nose goes away. It turns out that in some places I am enlarging my nose, but visually it is shrinking! Here's the thing! It's worth a try if you need it.

CLICK on one photo to view the entire photo gallery

Nose correction - before and after 1

Non-surgical rhinoplasty – 1

In this case, a young girl asked whether it was possible to correct a hump on her nose and raise the tip of her nose without surgery. She was also concerned that the tip of her nose droops quite far when she smiles. During the examination, it became clear that correction with filler is possible and the result will be sufficient. The drug was selected in a small volume and medium density.

The procedure is performed under local anesthesia with cream and is tolerated comfortably. The result is visible immediately. Slight swelling and bruising may occur, but is rare. The effect lasts 6-12 months, after repeated correction up to 18 months.

Cosmetologist's work:

• fix hump
• without surgery

• filler correction
• under local anesthesia

• Effect 6-12 months

Result

The achieved result is visible immediately. There is slight swelling on the nose, which will last for a few more days, but changes in shape are already obvious. Already on the first day, it is clear that the asymmetry has gone away, the tip of the nose has risen, and minor defects have disappeared.

There is no rehabilitation period as such. After a few hours, when the swelling decreases, you can return to work. Therefore, it is advisable to do the procedure on Friday evening, before the weekend. During the recovery period, you should avoid visiting a bathhouse, swimming pool, active sunlight, and also refrain from drinking alcohol and massage treatments.

Nose correction - before and after 2

Non-surgical rhinoplasty – 2

Almost always, a person who is planning nose correction with filler has a completely logical question: since additional volume is introduced, does that mean the nose will become larger? The concerns are understandable, because you are coming for a procedure to visually reduce your nose, not enlarge it. The answer is that the nose protrudes forward due to its shape, often with a hump.

The filler is injected at several points in such a way that the nose becomes almost straight, and sometimes even upturned, and thanks to this it seems to decrease in size. This is an optical illusion, but still. The nose does not become larger with proper distribution of the drug.

Cosmetologist's work:

• Make your nose smaller
• Short rehabilitation

• Effect 6-18 months
• Anesthesia cream

Nose correction - before and after 3

Non-surgical rhinoplasty – 3

A hump and deformation of the nasal bridge can be not only congenital, but acquired after an injury, for example, or illness. This is an even more annoying problem because usually the problem not only exists, but it progresses over the years. If nasal breathing is impaired, that is, the septum is deviated, then only surgical intervention is possible - surgical rhinoplasty.

But if the changes are only external, as in this case, then it is quite possible to do without surgery and correct this feature with filler based on hyaluronic acid. The effect lasts from 6 to 18 months, local anesthesia is creamy, the duration of the entire procedure, including pain relief, is no more than 45-60 minutes. Rehabilitation usually lasts 2-4 days, rarely up to 7

Cosmetologist's work:

• Procedure 45-60 min.
• Rehabilitation 2-4 days

• Effect 6-18 months
• Anesthesia cream

Nose correction - before and after 4

Non-surgical rhinoplasty – 4

The photo shows a great example of how a straighter and more even bridge of the nose can make the face more feminine and softer. Correct shadows, no recesses, no hump, the tip of the nose looks up - what could be more harmonious? This shape of the nasal bridge is an excellent basis for non-surgical rhinoplasty, that is, correction with filler based on hyaluronic acid.

The density of the drug is always selected during consultation - it can be a medium density or high viscosity gel. The correct selection determines the amount of the drug used, the usefulness of the effect, and its duration. The effect of filler is always temporary - 6-18 months, after repeated correction it lasts longer. The procedure is performed under local anesthesia, is tolerated comfortably, rehabilitation lasts 2-4 days.

Cosmetologist's work:

• The procedure is comfortable
• Rehabilitation 2-4 days

• Effect 6-18 months
• Anesthesia cream

Real effect after the procedure

Indeed, after injection of fillers, your nose will change, but the hump that bothers you will not disappear, but will only be masked by the injected gel, which fills the surrounding tissues in the area of ​​the bridge of the nose. This procedure is not suitable for patients with thick nasal skin, as there is a possibility of swelling, which, due to the density of the skin, will concentrate in the tip of the nose.

That is why whether to do such a procedure should be decided only by you, and only after consulting a specialist.

Nose correction - before and after 5

Non-surgical rhinoplasty – 5

Doesn't the nose become wider after correction? This is a very common question. When we smooth out the hump or raise the tip, the nose does not become wider; on the contrary, in some places it even becomes thinner and more miniature. But when it comes to the need to correct the “full face”, that is, asymmetry, when the nose has moved a little to the side or there are some depressions, then with just a little correction the nose can become wider. But the plus is that no one will notice this, because a straight nose always looks more aesthetically pleasing than a nose with asymmetry, even if it is 1-2 mm wider at the back.

In this photo you can see how correcting asymmetry changes the nose and the overall perception of the face for the better. The effect lasts up to 6-18 months. Local anesthesia, cream. The procedure time is 45-60 minutes with consultation and anesthesia. It feels like it can be carried comfortably. Rehabilitation from several hours to 3-4 days.

Cosmetologist's work:

• The procedure is comfortable
• Rehabilitation up to 4 days

• Effect 6-18 months
• Local anesthesia

Non-surgical rhinoplasty (fillers in rhinoplasty)

The content of the article

1. Definition of non-surgical rhinoplasty
2. What are fillers?

3. Anatomical aspects when performing rhinoplasty with fillers

• soft tissues of the nose
• effects on the nasal muscles with botulinum toxin
• blood supply to the external nose

4. Selection of patients for non-surgical rhinoplasty using filler

• indications for rhinoplasty with fillers
• contraindications to non-surgical rhinoplasty

5. Method of non-surgical rhinoplasty

• Pain relief before non-surgical rhinoplasty
• Drawing marking lines
• Filler injection areas
• Sequence of filler injection
• Post-injection adaptation of fillers

6. Possible complications

• bruises
• asymmetry
• visible contours of filler
• hypersensitivity
• lump formation
• inflammatory response and swelling

7. Vascular complications

• symptoms of intra-arterial embolism
• prevention of intra-arterial embolism
• rehabilitation and care

Definition of Non-Surgical Rhinoplasty

Rhinoplasty is one of the most common operations in aesthetic plastic surgery.

People of Asian ethnicity often have a flat nose and a wide nasal tip, so augmentation rhinoplasty is often performed in Asian countries.

However, existing methods of rhinoplasty using implants and autologous (own) cartilage are associated

• with long recovery time,
• high cost and
• possible problems associated with the implants themselves.

Therefore, patients often have a psychological barrier when considering the possibility of rhinoplasty. Many patients choose not to undergo surgery. This, in turn, leads to an increase in the popularity of rhinoplasty without surgery and a scalpel - to correct nasal defects with the help of fillers.

The purpose of this article is not to endorse the use of fillers, but to

• firstly, providing information and guidance to patients to understand the process inside and out,
• secondly, for practitioners - to improve the results of injection non-surgical rhinoplasty and, accordingly, reduce complications for many practitioners performing this procedure.

What are fillers?

A filler is any material that can add volume when injected into the body and is usually an injectable material.

Well-known fillers include

• hyaluronic acid (HA) products,
• collagen,
• paraffin,
• liquid silicon.

Fillers are usually classified by their components.

Fillers are also classified by durability.

• Fillers that last less than 2 years are called temporary fillers;
• lasting 2 to 5 years are called semi-permanent fillers;
• and those that last at least 5 years after injection are called permanent fillers.

Fillers can also be classified according to their mechanism of action, e.g.

• fillers to increase volume and
• stimulating an increase in volume.

Fillers that stimulate volume expansion by stimulating fibroblasts to synthesize collagen through an inflammatory response are called stimulating fillers.

Most fillers have a good safety profile. However, serious side effects such as granuloma formation and inflammation due to tissue reaction have been reported with some fillers, so it is necessary to carefully select the desired filler by studying all its characteristics.

Ideal filler

• should not cause tissue reactions,
• must be durable, safe and easy to use,
• should not migrate in tissues and
• should not cause allergic reactions.

Anatomical aspects when performing rhinoplasty with fillers

Non-surgical rhinoplasty with filler can only be successfully performed if the plastic surgeon has a good understanding of the anatomy of the nose.

No-scalpel rhinoplasty with filler is a procedure to reshape the nose by injecting filler into the space between the osteochondral structure of the nose and the skin.

It is very important that the monolithic frame of the anatomical structures of the nose is strong, as a supporting structure to maintain the shape of the injected filler and to achieve a good aesthetic result.

Therefore, you cannot expect a satisfactory result after the procedure if the nasal frame is deformed or weakened.

When performing rhinoplasty using filler, it is necessary to take into account all the characteristics of the anatomical structures of the nose, including such

• thickness and properties of skin and soft tissues, as well as
• size, shape and strength of cartilage and bone.

Soft tissues of the nose

Before performing injection rhinoplasty, it is important to evaluate the condition of the skin of the nose. In general, Asians have thicker skin than Europeans, with well-developed subcutaneous fat.

The soft tissue of the bridge of the nose is thickest, and the thinnest is in the area of ​​the nose, which is the junction of the upper lateral cartilages and the bones of the nose.

There are 4 layers between the skin and the osteochondral skeleton:

• superficial fat layer,
• fibromuscular layer,
• deep fat layer and
• periosteum or perichondrium.

When performing injectable rhinoplasty with filler, it is difficult for patients with thick, oily skin to achieve a predictable three-dimensional shape because they often experience significant swelling after the procedure.

On the other hand, in such patients, minor irregularities or asymmetries are more easily camouflaged compared to patients with thin skin.

The main blood vessels of the external nose are located in the superficial musculoaponeurotic system (SMAS) layer or in the superficial fat layer.

Therefore, the ideal layer for filler injection to minimize vascular damage is the deep fatty layer located between the SMAS and the perichondrium, or periosteum.

Effects of botulinum toxin on the nasal muscles

Blocking (restricting movement) of the paranasal muscles due to the action of botulinum toxin gives better and longer lasting results than using filler alone.

Understanding the location, size and function of the nasal muscles is very important.

To enhance the effect of non-surgical rhinoplasty, you can use botulinum toxin to cause controlled immobilization (paresis/paralysis) of the muscles.

Let's discuss muscles and the practical significance of blocking them.

The depressor septum nasalis muscle originates from the orbicularis oris muscle and ends in the medial crura of the inferior lateral cartilage. This muscle lowers the tip of the nose when smiling and can often be immobilized with a botulinum toxin injection to suppress its function.

It is better to block (paralyze) the procerus muscle (m.procerus), located in the area of ​​the glabella, with botulinum toxin in advance, because the filler injected into the area of ​​the glabella can be displaced during intense contraction of the muscle.

The levator labii superioris muscle causes the alar flares to widen and the tip of the nose to lower when smiling; therefore, it is also often blocked by botulinum toxin in patients with dynamic nasal tip ptosis.

Blood supply to the external nose

The most dangerous complications of filler injection are intra-arterial embolization (blockage) of a blood vessel and dermal necrosis (death) due to compression of blood vessels. To prevent such consequences, the plastic surgeon must have a good knowledge of the blood supply to the external nose.

Both the internal and external carotid arteries supply blood to the external nose through the ophthalmic and facial arteries, respectively.

The ophthalmic artery primarily supplies blood to the superior part of the nose through the external nasal branch of the anterior ethmoidal artery and the posterior nasal artery.

The facial artery gives rise to the angular and superior labial arteries, which supply blood to the lower part of the nose. Each of these branches branches into the lateral nasal artery and the columellar artery.

The tip of the nose receives its blood supply from the dorsal nasal artery superiorly, the lateral nasal artery, and the columellar artery inferiorly.

Selection of patients for rhinoplasty with filler

The plastic surgeon must be able to select patients who are suitable for rhinoplasty with filler. This requires a thorough understanding of the ideal aesthetics and anatomy of the nose (described earlier).

Unless doctors are trained and have thorough knowledge, they should not administer fillers into the nose. Patients who cannot achieve good results with filler should undergo surgery.

Indications for rhinoplasty without surgery

The group of patients who typically have good results includes patients

• with a moderate hump on the bridge of the nose,
• with a slightly crooked nose,
• with a high nose tip with a flat base,
• slight imbalance after surgery.

Contraindications to non-surgical rhinoplasty

Satisfactory results in patients are not expected

• with a moderate to severe nasal hump,
• strongly crooked nose,
• upturned and convex nose.

In patients with such initial data, good results cannot be obtained from filler injection alone.

Clinicians should also exercise caution when offering this procedure to patients who have had nasal implants or those who have had a history of paraffin or liquid silicone injections, as skin irregularities and vascular compromise may occur.

Non-surgical rhinoplasty technique

Rhinoplasty using filler can be performed from 2 main areas:

• injections through the bridge of the nose and
• injections through the tip of the nose.

The bridge of the nose has a strong, dense structure, created by the nasal bones and upper lateral cartilages, so this area is easier to correct (lift) with filler injections.

However, raising or lengthening the tip of the nose is not easy, especially in Asians, due to weak supporting structures.

After comparing and analyzing the patient's nose, the plastic surgeon must decide which part should be raised and by how much.

Pain relief before non-surgical rhinoplasty

Applying a local anesthetic ointment for about 40 minutes before the procedure is usually sufficient for pain relief. A bandage placed on top may enhance the effect of the local anesthetic.

Drawing marking lines

After anesthesia, the midline along the dorsum of the nose is marked. It should be accurately marked to prevent complications such as imbalance or intravascular injection because the blood vessels are generally not located in the midline of the nose.

It is important to find the ideal starting point for the nasofrontal angle.

The nasal root should begin at the level of the supratarsal fold in lateral view, but this varies depending on patient preference, forehead height, and nasal length.

The bridge of the nose should lie 1-2 mm below the line drawn from the root to the tip of the nose. Some patients, however, may prefer a straight nasal bridge.

Filler injection areas

The nose is divided into 4 parts for the procedure - the root, rhinion, supratip zone and tip.

Each part has different thickness of subcutaneous tissue, as well as different characteristics and strength of supporting structures, so different injection methods must be used.

After marking the 4 sections, any defect on either side of the nose should be noted.

In the tip and supratip zones, the thickness of the soft tissues is much greater than in other zones, and the underlying structures here are mostly concave in shape.

Therefore, a slightly larger volume of filler must be injected into these 2 areas to avoid indentations due to pressure from the overlying soft tissue.

Sequence of filler injection

The filler is usually injected in the following order: first into the root area, then the rhinion, then the tip and finally the supratip.

The reason that tip filler is injected earlier than supratip filler is that tip support is poor, especially in Asians, making it difficult to predict the amount of tip projection that can be achieved.

If filler is injected first into the supratip area and then into the area of ​​the nasal tip, then the doctor will not be able to achieve adequate projection of the nasal tip, and this can lead to deformation.

The correct technique for injecting filler into the tip of the nose allows you to avoid serious complications.

The areas where filler is typically injected in the nasal tip area are the interdomal area, the concavity area of ​​the lateral crura of the greater alar cartilages, and the area between the medial crura of the greater alar cartilages.

Injecting filler into the tip of the nose creates volume to reshape the nose. The volume and location of the injection depend on the desired appearance of the nose.

When injecting filler into the tip of the nose, it is safer to insert it in the midline to minimize tip deviation and asymmetry.

Minor wing retraction can be corrected with a filler injection. However, this is not recommended for patients who have scars from previous surgery due to the risk of skin necrosis or other abnormalities.

The fanning technique of filler injection, in which the filler is deposited as the syringe needle is withdrawn after injection, is the most commonly used technique.

Sometimes there is a single injection using a 2.5-inch needle, and sometimes multiple injections using a small 0.5-inch needle.

The procedure can also be performed using a blunt cannula and this method is recommended for beginners as there is less chance of complications such as intravascular injection, but it is more difficult to achieve accurate results.

The most important aspect of using filler to reshape the nose is to perform the procedure without deviation from the midline.

The most common complaint after any rhinoplasty is asymmetry or imbalance. This also applies to rhinoplasty using filler.

As discussed earlier, the clinician should always mark the midline on the bridge of the nose and perform the procedure without deviation from the midline to minimize such complications.

It is highly recommended that clinicians use both hands when inserting the filler. When using only one hand to inject, the non-injecting hand must guide the needle and filler into the tissue. This ensures minimal bleeding or spraying of the product.

Post-injection adaptation of fillers

After the injection, it is recommended to perform a gentle massage to mold and smooth out the filler. Any area that is overfilled should be pressed into the base, and areas that are underfilled should receive additional injections.

It is recommended to carry out follow-up no earlier than 2 weeks, since after the procedure slight swelling may occur, which interferes with an adequate assessment of the result. No special dressings or antibiotics are required.

Possible complications

Reshaping your nose with filler is safe, but complications can sometimes occur. Most complications can be prevented by choosing safe products and following the procedure correctly.

The most common complications of filler injections are

• edema,
• erythema,
• bruises,
• color change,
• unevenness,
• formation of lumps and granulomas.

Infections and serious complications such as skin necrosis may occur due to vascular administration of the drug.

Bruises

Bruising is a common complication of filler injections; this is caused by damage to blood vessels from the needle. To reduce bruising, puncturing the muscle layers during filler injection should be minimized, the injection site should be cleaned with an alcohol swab, and the procedure should be performed in a brightly lit room.

Patients should be informed not to take blood thinners such as aspirin 1 week before the procedure.

Applying ice packs to the injection site immediately after the procedure helps minimize bruising, and special needles or cannulas are used to minimize vascular damage.

If bleeding occurs during the procedure, cover the injection site with gauze and apply pressure for several minutes to avoid the formation of a hematoma.

Patients should be informed that bruising is temporary and does not affect the final aesthetic result. You should also understand that the bruise may darken a few days after the injection, but will gradually disappear over about 10 days.

Asymmetry

One of the most common complications of rhinoplasty using filler is asymmetry. To avoid asymmetry, the tip of the needle should be located exactly along the midline, and the direction of the bevel should be towards the midplane.

When administering filler to a patient with a crooked nose, it is advisable to carefully monitor the shape of the nose while slowly injecting a small amount of filler.

Visible contours of filler

Injecting filler superficially (close to the surface of the skin) may result in an uneven injection site or appearance. To avoid this, the filler should be introduced into the appropriate layer in accordance with its characteristics.

Hypersensitivity

Sometimes hypersensitivity to filler ingredients may occur. The main symptoms are pain and erythema, accompanied by itching and fever.

In most cases, these symptoms disappear as the filler dissolves. In severe cases, corticosteroids and warm compression may help relieve symptoms.

Pulsed dye laser treatment can be used for persistent erythema. Many reactions that are considered allergic or hypersensitivity reactions are most likely caused by bacterial reactions.

Formation of lumps

After injection of filler, lumps may form - these are either due to granuloma or nodule formation.

Granuloma is an immune-mediated response to an injected foreign body and forms through the accumulation of immune response-associated cells such as lymphocytes.

Treatment is with corticosteroid injections or surgical removal.

The nodules are round and hard in shape. Their development is a common complication after the use of fillers for soft tissue augmentation. They can be inflammatory or non-inflammatory in nature.

Inflammatory nodules may appear days or years after treatment, whereas non-inflammatory nodules are usually visible immediately after implantation and are usually secondary to improper placement of the filler.

Treatment is with hyaluronidase (if HA is used as filler), corticosteroids, or surgery.

Inflammatory response and swelling

Sometimes the inflammatory response and swelling occurs due to a protein component, such as endotoxin, contained in the filler and leads to skin damage.

This is caused mainly by the HA filler and symptoms such as erythematous swelling, skin hypertrophy and pustules may appear a few days after the injection.

Symptoms occur at all filler injection sites and resolve with appropriate antibiotic treatment and dressing.

Vascular complications

The most serious complications that can occur with filler injection are skin necrosis and blindness.

The mechanism leading to tissue necrosis after injection of HA filler is not fully understood.

Vascular disorders are divided into

• intravascular and
• extravascular.

Intravascular factors include direct occlusion of the arteries by large molecule excipients and chemical damage to the endothelial lining or impurities in excipients.

Extravascular causes include extrinsic compression of the vessel due to excessive injection volume or swelling and inflammatory response caused by filler components.

Intra-arterial embolism

The cause of most cases of intra-arterial embolism after rhinoplasty with filler occurs when the filler is injected directly into the nasal or lateral nasal artery.

The dorsal nasal artery, as its name suggests, runs along the dorsum of the nose approximately 3 mm from the midline. The tip of the needle can be inserted into a blood vessel if it is inserted parallel to the blood vessel.

The dorsal nasal artery anastomoses with the ophthalmic, subtrochlear, and angular arteries, so if an embolus occludes a vessel in this area, it will manifest itself as local skin necrosis.

But if the filler embolus spreads deeper into the ophthalmic artery, it can cause ocular symptoms.

Symptoms of intra-arterial embolism

Intra-arterial embolism is rare, but its consequences are devastating.

After filler is injected into the arterial bloodstream, patients experience severe pain and sometimes complain of a feeling that something is spreading from the injection site.

The area of ​​the blood vessel where the filler embolism occurred becomes pale due to ischemia. The ischemic area develops swelling within a few hours, which soon becomes purple and mottled due to venous stasis.

After about 24 hours, multiple ulcerative lesions may appear, accompanied by erythema, leading to desquamation of the tissue. The situation usually gets worse over time. After this, certain signs of dermal necrosis, such as eschar formation, may gradually appear, and then the skin is restored through the wound healing process.

Prevention of intra-arterial embolism

During the procedure, the needle tip should always be positioned in the midline to avoid injection into the dorsal nasal artery as it runs parallel to the midline at a distance of 3 mm.

If filler is being inserted from the side of the nasal bridge, for example to correct a crooked nose, the needle should never move parallel to the direction of the blood vessels. Once the needle is inserted in the midline, the tip of the needle should be moved to the side while injecting the filler to prevent injection into the blood vessel, although some bleeding may occur due to damage to the vessel.

The dorsal nasal artery is located in the superficial fat layer and SMAS; therefore, the injection must be made into the deep fat layer to prevent embolization. Using a blunt cannula can also be helpful for new doctors who are not familiar with injection techniques.

Rehabilitation and care after intra-arterial embolism

If the patient complains of severe pain and there is blanching of the skin along the blood vessel area during the filling procedure, the injection should be stopped immediately and aspirate as much of the filler as possible.

If a hyaluronic filler has been injected, an injection of hyaluronidase is recommended, as current evidence suggests that when hyaluronidase is injected around an artery, some of it may diffuse through the lining of the vessel.

It is also recommended that hyaluronidase injections are always performed regardless of the type of filler injected, because hyaluronidase can reduce interstitial pressure.

Low molecular weight heparin therapy has been reported to reduce thrombosis and embolism and should therefore also be used in such cases.

It is important to provide sufficient oxygen to the ischemic area. For this, hot wraps and soft massage are used, and 2% nitroglycerin paste is used to dilate blood vessels.

If possible, it is helpful to start hyperbaric oxygen therapy. Appropriate antibiotics are prescribed to prevent secondary infection. Administration of prostaglandin E1, 10 mg daily for 5 days, is effective. After about 1 day, an appropriate bandage should be applied as soon as peeling and pustules occur. A moist dressing should be used to promote faster wound healing and antibiotics should be continued.

To avoid such problems, the patient needs to choose a plastic surgeon wisely.

Nose correction - before and after 6

Non-surgical rhinoplasty – 6

A fairly common situation is when a whole syringe of filler for nose correction turns out to be too much and we have the opportunity to refresh another area on the face. Mostly, patients choose the lips as the second correction zone. A small amount can make a very delicate correction, but in general, after working on the nose and lips, the face is truly transformed. Pay attention to the photo - the correction is not noticeable, but at the same time the lips have become more expressive, more sensual and positive, and the nose is visually shorter and looks neater on the face - more straight and upturned.

This correction was carried out using 1 ml of hyaluronic acid filler and took about 60 minutes. The effect will last for 8-12 months. Local anesthesia cream. The procedure feels comfortable. Rehabilitation in the nose area: 2-4 days, lips up to a week.

Cosmetologist's work:

• The correction is invisible
• Rehabilitation up to 4 days

• Effect 6-12 months
• Local anesthesia

• 1 ml filler

Recovery

Unlike plastic surgery, contour plastic surgery with fillers has a short recovery period.

In our clinic, a cannula technique for introducing filler is used for nose correction. The cannula is a long wire with a blunt end that can go around any subcutaneous obstructions. It does not injure tissue and makes the procedure painless. The risk of postoperative complications, which include swelling and hematomas, is minimized.

To ensure a successful recovery, you should follow the following recommendations from a specialist:

• apply a cold compress to your nose;
• avoid hypothermia and injury;
• refuse to visit the bathhouse or solarium;
• do not wear glasses;
• do not massage your face;
• refuse heavy physical activity.

Nose correction - before and after 7

Non-surgical rhinoplasty – 7

Quite often people come to the appointment for advice on nose correction. Basically to hear that there are no options, surgery is needed. And indeed, when there is pronounced asymmetry, the nose does not breathe due to a displaced septum, or, for example, there is a desire to significantly reduce the size of the nose, then of course you should immediately see a surgeon. And when the size of the nose is not so important, but you just want to visually smooth out the hump and thereby “soften” the facial features, then a cosmetologist can almost always help.

So it is in this case. We needed 1 procedure to smooth out the hump and lift the tip of the nose. The nose became straighter, even slightly upturned. The patient was pleased with the effect. In this case, the remaining filler in the syringe was used to lightly beautify the lips, which enhanced the effect of softness and femininity. A total of 1 ml of filler for both areas.

Cosmetologist's work:

• The procedure, including pain relief, lasts 1 hour.
• Application anesthesia - with a special cream

• The procedure is comfortable and well tolerated
• Rehabilitation 1-7 days. Effect up to a year.

Method capabilities

The advantages of the technique include low trauma and rapid recovery. However, in this way it is impossible to solve many problems associated with the functioning of the organ. A deviated septum that causes difficulty breathing can only be corrected through surgery. Non-surgical rhinoplasty is a purely aesthetic procedure. With its help, you can remove the hump and make the nose sag, eliminate asymmetry and various defects in the form of dimples and depressions on the nose. To a certain extent, correction of excessively wide nasal wings is possible.

Often, non-surgical rhinoplasty is used in addition to traditional rhinoplasty to add the finishing touches. The method allows you to remove minor imperfections or details that for some reason do not satisfy the patient.

Non-surgical rhinoplasty is an effective and popular procedure, despite the fact that it cannot be called an alternative to classical rhinoplasty performed by a surgeon.

Nose correction - before and after 8

Non-surgical rhinoplasty – 8

A common reason for people seeking nose correction is unevenness of the nasal bridge. In profile and from the front, the nose can be perfect and chiseled, but in projection the half-cup has some irregularities that create the effect of a hump. For those who find this feature significant, injection rhinoplasty with hyaluronic acid fillers may well be indicated. The drug is administered at several points in such a way that the line of the nose from any point of view becomes ideal.

In this case, 0.6 ml of medium density filler was used. The procedure took 45 minutes including pain relief. The patient tolerated it very well. Rehabilitation lasted about 2-3 days (there was slight swelling on the back of the nose). The effect of the procedure lasts up to 1 year.

Cosmetologist's work:

• 0.6 ml medium density filler
• The procedure took 45 minutes

• Rehabilitation 2-3 days
• The effect of the procedure is up to 1 year

Nose correction - before and after 9

Non-surgical rhinoplasty – 9

In this case, the patient wanted to reduce the severity of the hump and the drooping of the tip of the nose during facial expressions, in particular when smiling. Such corrections are possible using a combination of Botox + filler, or using one method. Here we only used filler. The photo shows how nose contouring allows you to change the profile - the nose becomes visually smaller, the tip of the nose is perkier, including when smiling, the girl’s facial features are softer.

This procedure took about an hour. It was performed under anesthesia with a special cream, and the patient tolerated it very well. The recovery period is 1-7 days, it depends on whether bruises appear after the injections. In the case of non-surgical rhinoplasty, bruises are rare. The effect in the case of a pronounced hump after the first procedure usually lasts up to six months, but the hump does not appear to the same extent, it just becomes a little more visible. After repeating the procedure, as usual, the effect lasts up to a year.

Cosmetologist's work:

• Pain relief with a special cream
• Effect up to six months

• The procedure took about 1 hour
• Repeatedly - Effect up to 1 year

Lipofilling

The lipofilling method, or lipomodeling, is one of the latest technologies in aesthetic medicine.
The principle of the method is based on the introduction of the patient’s own fat tissue into the subcutaneous tissue of the correction zone. The buttocks or the lower anterior wall of the abdomen act as a donor of fat cells. The recipient zone can be any part of the body whose contours need to be changed. The indications for non-surgical rhinoplasty using lipofilling are the same as for filler injection: superficial skin defects, a depression on the back, minimal asymmetry, a small hump. Dramatic changes are difficult to achieve. The method is more often used in complex rejuvenation and improvement of appearance simultaneously with lipofilling of cheekbones, lips, nasolabial and nasolabial folds. In this case, fat grafting gives an excellent aesthetic result.

Lipomodeling is not a non-surgical technique. This is a minor surgical intervention that is performed in a surgical hospital by a plastic surgeon. According to indications, before nose correction, anesthesia is performed or the patient is immersed in a state of medicated sleep. After surgery, it is necessary to follow the doctor’s recommendations to improve the survival of fat cells in the recipient area.

Benefits of lipofilling. Minimal blood loss and tissue injury, minimal postoperative risks. No swelling, hematomas or bruises after the procedure. Wide possibilities for subsequent correction, the need for which may arise when the severity of age-related changes increases. (An example of age-related changes is drooping of the tip of the nose.)

Disadvantages of nose correction using lipofilling. Limited options: lipomodeling can only correct minor defects. Another subjective drawback is the relatively high cost of the procedure.

Nose correction - before and after - 10

Non-surgical rhinoplasty – 10

In my practice, I often encounter patients asking me to correct two areas at the same time - the nose and lips. In fact, this option gives excellent results if there are indications for it. In this case, the patient’s “before” nose does not have a noticeable hump and is very neat. The need for correction arose because he sank down during facial expressions.

A very small amount of filler was used to correct the nose and we used the remainder of the product for light dynamic beauty of the lips. The result in both areas was more than natural and the patient was satisfied. The procedure, including anesthesia, took about an hour. Rehabilitation takes up to 7 days, as the lips react to injections with swelling and bruising. The effect lasts up to a year.

Cosmetologist's work:

• Pain relief with a special cream
• Effect up to a year

• The procedure took about 1 hour
• Rehabilitation up to 7 days

How do you prepare for surgery?

Preparation for surgery begins with consultation and examination. The surgeon listens to wishes and gives his recommendations, based on the individual characteristics of the structure of the nose and face as a whole, so that after rhinoplasty the result looks harmonious.

During preparation, an initial examination is important to assess the condition of the tissues, structure and determine the extent of surgical intervention. You can finally decide on the type of rhinoplasty after an x-ray.

3D modeling helps you see your future nose and entire appearance. For this purpose, photographs in three projections are used. Although the final result may differ slightly, because the program does not take into account the individual reaction of the body.

In preparation for rhinoplasty, the surgeon develops a surgical plan.

The doctor refers you for consultation to other specialists: otolaryngologist, anesthesiologist, therapist. Sometimes a consultation with a psychologist is necessary.

Analyzes and research

Tests and examinations are a necessary stage of preparation for surgery. Mandatory minimum includes:

• general blood analysis;
• fluorography;
• blood for Rh factor group and biochemistry;
• blood test for prothrombin;
• tests for RW (syphilis), hepatitis B, C, HIV;
• ECG with conclusion;
• radiography of the paranasal sinuses.

Additional tests may be ordered. Therefore, the attending physician must know about all pathologies, chronic diseases, bad habits, and allergies. Information is collected during anamnesis.

Restrictions

For those who decide to have surgery, there are some restrictions:

• one month before surgery, you should not sunbathe or visit a solarium;
• Deep peeling is prohibited for a month;
• two weeks before surgery you should not smoke or drink alcohol;
• It is necessary to stop taking blood thinners, antibiotics and hormones for two weeks.
• Those who wear glasses should purchase contact lenses in advance.

The day before surgery, you should only eat light food. On the day of rhinoplasty, you should not eat or drink anything. On this day you need to take a warm shower, wash your face, do not apply decorative cosmetics and remove all jewelry.

Nose correction - before and after - 11

Non-surgical rhinoplasty – 11

Correcting a hump is the most common reason for seeking non-surgical rhinoplasty. This is quite understandable, because in profile, the presence of a hump and recess in the area of ​​the nose visually enlarges even the most neat nose. In this case, this trend is very clearly visible in the “before” photo. In this case, a small amount of filler was used to achieve the full effect of leveling the hump, in addition to slightly raising the tip of the nose. The “after” photo shows how much the profile of the face and nose can change even after a very minor correction.

The procedure took about 45 minutes. Anesthesia with a special cream. The patient tolerated the procedure easily and said that she felt comfortable. Rehabilitation 1-7 days. The effect lasts up to a year and disappears gradually. After a repeated procedure, as a rule, its duration is longer.

Indications

Rhinoplasty with fillers or threads is indicated only in 5-7% of cases.

Among the most common indications are:

• Drooping tip or wings of the nose;
• Wide or thin nose;
• The presence of a hump;
• Snub nose;
• The need to correct the tip of the nose;
• Asymmetry.

Cost of non-surgical rhinoplasty