Rod J.Rohrich, Nikhil Agrawal, Yash Avashia, Ira L.Savetsky
Patients are constantly searching for more ways to achieve their aesthetic concerns without considering the high cost or down time of surgery, and rhinoplasty is no different. Food and Drug Administration–approved hyaluronic acid (HA) soft-tissue fillers can be used to augment or refine nasal irregularities, and use of this implant has broadened the rhinoplasty surgeon’s armamentarium. Fillers can also be used to correct small asymmetries following rhinoplasty.
Using photographs and a mirror during and immediately after the procedure can help the surgeons to make sure that the patients’ concerns are being met. It is important to discuss with the patients what can and cannot be achieved with soft-tissue fillers. The patient should know that rhinoplasty using a filler liquid is temporary and that the patient’s nose will become bigger after the injection.1The level of injection must be deep and midline to maximize safety and to avoid both skin loss and potential blindness. To minimize the risk of intravascular injection, one must take into consideration the subcutaneous location of the nasal vessels superficial to the nasal muscles along with the rich plexus of vessels, with contributions from the angular, supraorbital, and supratrochlear arteries. (See Video 1 [online], which displays the arterial anatomy around the nose as well as a patient who is receiving nonsurgical nasal augmentation, including a neuromodulator injection into the depressor septi nasi.)
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