Dermal Fillers in Secondary Rhinoplasty

INTRODUCTION:

Rhinoplasty is one of the most common surgical procedures performed by plastic surgeons worldwide. Over the years there have been numerous anecdotal reports of dorsum irregularities, and loss of tip definition post rhinoplasty. Subsequent surgical revisionary procedures can aggravate the problem causing an even noticeable dorsum irregularities and less defined nasal tip. The final result can be often worse than the preoperative condition and difficult to correct. (1,2)

The use of injectable fillers for nonsurgical rhinoplasty has increased tremendously over the past decade. With the advent of newer injectables with greater longevity, and less immunogenicity, nonsurgical rhinoplasty has become a viable alternative to revisionary surgery. An understanding of the surgical anatomy of the nose, particularly in a postrhinoplasty patient, affords the plastic surgeon injector the opportunity to better plan the injectable treatment.(3,4,5)

The aim of this work is to outline the evolution of nonsurgical rhinoplasty and identify properties to consider when selecting which dermal filler to use. It includes a description of the types of postrhinoplasty deformities that can be treated with injectables, as well as the role of nonsurgical rhinoplasty in a comprehensive regimen for correction of nasal deformities. This review describes the most commonly used fillers and their indications in the context of recent reports of both their successes and failures.

METHODS:

Retrospective chart review between March 2006 and December 2017. Clinical and demographic features of the patients, technique, satisfaction rates, and complications were recorded.

RESULTS:

135 patients that had undergone nonsurgical postrhinoplasty procedures with dermal fillers were included in the study. We recorded a high satisfaction rate and observed a 7% complication rate. 

CONCLUSIONS:

Non-surgical nose augmentation with dermal fillers is an easy, safe, and comfortable technique. It appears that plastic surgeons need to assume a more active role in nonsurgical postrhinoplasty procedures not as a substitute for the revisionary surgery, but as an option in selected patients.

REFERENCES:

1- Gruber RP, Galvez MG, Ulvila DD. Postrhinoplasty fibrotic syndrome. HNO. 2018 Jan;66(1):26-31.

2- Stupak HD, Moulthrop TH, Wheatley P, Tauman AV, Johnson CM Jr. Calcium hydroxylapatite gel (Radiesse) injection for the correction of postrhinoplasty contour deficiencies and asymmetries. Arch Facial Plast Surg. 2007 Mar-Apr;9(2):130-6.

3-Jasin ME. Nonsurgical rhinoplasty using dermal fillers. Facial Plast Surg Clin North Am. 2013 May;21(2):241-52.

4- Thomas WW, Bucky L, Friedman O. Injectables in the Nose: Facts and Controversies. Facial Plast Surg Clin North Am. 2016 Aug;24(3):379-89.

5- Schuster B. Injection Rhinoplasty with Hyaluronic Acid and Calcium Hydroxyapatite: A Retrospective Survey Investigating Outcome and Complication Rates. Facial Plast Surg. 2015 Jun;31(3):301-7.