What is non-surgical rhinoplasty?
Non-surgical rhinoplasty is a medical cosmetic procedure that addresses and corrects a number of aesthetic concerns regarding the nasal area and overall facial symmetry. Unlike traditional surgical rhinoplasty, the results of non-surgical rhinoplasty are temporary. Despite this, many patients report a high level of satisfaction with the procedure.
One study performed between January 2016 and January 2017 that involved 35 patients found that patients reported extremely high levels of satisfaction; plus, researchers did not observe any complications throughout the study.
Non-surgical rhinoplasty uses dermal fillers to augment or re-shape the nasal area. The most commonly used dermal fillers for non-surgical rhinoplasty are made of hyaluronic acid. Using the right combination of dermal filler and injection technique, practitioners can balance dorsal aesthetic lines and correct dorsum problems, enlarge the rotation and the projection of the nasal tip, and adjust nasal width. Dermal filler injection can also correct imperfections after surgical rhinoplasty. This includes saddle nose (loss of height), inverted-V (V-shaped indentation at the end of nasal bones and the beginning of the upper lateral cartilages), and pollybeak (excess contour in the area above the nasal tip).
This procedure provides an effective solution for nasal reshaping and profile balancing without the risks of traditional rhinoplasty surgery, such as scarring and complications from anaesthesia. As such, the procedure is becoming increasingly popular, with many benefits over surgical rhinoplasty. Non-surgical rhinoplasty is quick, requires little downtime, and has few complications, making it a popular choice for many patients. However, there are some danger zones at the injection sites for this procedure that practitioners must be aware of in order to perform a safe and effective non-surgical rhinoplasty.
Danger Zones of the Injection Sites
Non-surgical rhinoplasty should only be performed after a practitioner has received the proper training. Though the procedure does not carry as many risks in regard to adverse effects as surgical rhinoplasty, dermal filler injection still requires skill and knowledge of the injection area.
If performed incorrectly, non-surgical rhinoplasty can be very dangerous, leading to serious vascular complications that can cause skin necrosis and even blindness. Though management is possible in some cases of vascular complication, permanent damage, such as intense scarring, is possible. This is why practitioners must be aware of the danger zones in injection sites and learn how to avoid complications.
The nasolabial angle, or anterior nasal spine, is formed by the fusion of two maxillary bones in the middle of the nose. It is located above the philtrum, at nostril-level. The danger area for which practitioners must be cautious of in this injection site is the columellar artery from the superior labial artery. As the superior labial artery in the columellar branches passes on both side of the anterior nasal spine, it is safest to place the dermal filler injection in the midline on the bone.
The columella, or aneterior septum, is an area that consists of medical cruses of lower lateral cartilages and septal cartilage. Also known as the septal branch of the superior labial artery, the columellar artery has anastomosis with the lateral nasal artery from the facial artery. Branches from the columellar artery also form a part of the Kieselbach plexus. If the dermal filler injection goes too deep in this area, it can cause bleeding from the nose from the plexus.
The columellar artery may also have a direct anastomosis to the ipsilateral or contralteral infraorbital artery (also called the oblique columellar artery variant), though this occurs rarely. A sneezing reflex may be triggered when injecting in this area, as sensation in the columellar skin comes from the maxillary division of trigeminal nerve, which gives superior anterior dental branches.
The tip of the nose carries a very powerful blood supply from multiple angles. It supplies blood interiorly from the columellar artery, laterally from the lateral nasal artery, angularly from the facial artery, and superiorly from the dorsal nasal artery and from the ophthalmic artery. Due to this bilateral supply of blood, it is very rare for skin necrosis to occur on the tip. However, it also make this area a danger zone, as obstructing this blood supply during dermal filler injection can cause major damage.
In terms of sensory innervation, feeling in the tip of the nose is supplied by both ophthalmic (nasocilliary and ant ethmoidal branches) and maxillary division (infraorbital and zygomatic branches) of the trigeminal nerve.
Cartilaginous dorsum and bony dorsum
When injecting a dermal filler for non-surgical rhinoplasty into the nasal dorsum, practitioners should be aware that the lateral nasal artery and angular artery from the facial artery are danger zones. The supratrochlear artery and dorsal nasal artery from the ophthalmic artery also present a risk during injection.
Anastomosis nasal dorsum injections can cause blindness in the patient if filler is injected into the artery. This is because the dorsal nasal artery has a direct anastomosis with the angular artery. To avoid complications, dermal injections on the cartilaginous dorsum and bony dorsum need to be deep on the bone or cartilage, and injections should be as close as possible to the midline.
Alar lobule skin
Practitioners must be careful when injecting in the alar lobule, as they can change the shape of the nostril. As such, injections should be minimal. Additionally, blood supply in the area is unilateral, so arterial occlusion can easily cause skin necrosis.
The biggest danger zone in the alar lobule is the lateral nasal artery from the facial artery, which is located at the superior portion of the alar grove. To avoid complications in this area, aspirate before injecting the dermal filler.
As an increasing number of patients request non-surgical rhinoplasty to correct facial imbalances and nasal imperfections, it is vital that practitioners become well-versed in the anatomy of the nasal areas and the danger zones of the injection sites. Non-surgical rhinoplasty should only be performed by experienced injectors with prior experience with advanced treatments on the face. Aspirating prior to injection is crucial to avoiding complications, and slow and low-pressure injections are the safest way to perform this procedure. In addition to familiarizing themselves with the anatomy of the nasal area and the danger zones, practitioners should always ensure that injections occur in a sterile environment with an anaphylaxis emergency kit and hyaluronidase on hand.