ARtiCLe | RHINOPLASTY | Figure 6 Example of
secondary correction using the mini-rhinoplasty procedure; (A) before and (B) after
elevator muscles, depressors, compressors, or dilating
of the nostrils. Their role is generally modest apart from the depressor of the septum (i.e. depressor septi nasi). The role of this muscle is as a direct antagonist of the other muscles of the nose, drawing the ala of the nose downward, and thereby constricting the aperture of the nares. The other muscle groups are less important in the dynamics of the nose, but all are perfectly responsive to the action of botulinum toxin. The vessels and nerves of the nose also require an
in-depth understanding on the part of the physician (Figure 9). There is a high risk of vascular or nerve injuries, depending on the type of filler injection used. Vessels are small in size on the level of the angular area of the internal eye. This vascularisation is ensured by the arterial branches of the internal carotid network (ophthalmic) and external carotid artery (facial artery). The veins drain towards the angular vein essentially, but also towards the facial vein. With regard to innervation, the branching engines
the vessels
and nerves of the nose also require an in‑depth
understanding
on the part of the physician. there is a high risk of vascular or
nerve injuries, depending on the type of
filler injection used.
come from the facial nerve and the sensitive branches emanate from the trigeminal nerve via the external nasal nerve, from the infraorbital nerve, and the nerve naso-lobar.
The products The author has used a range of filler products when treating the nose (e.g. polylactic acid, polyacrylamide gels, calcium hydroxylapatite, hyaluronic acid). Taking into account the smoothness of the cutaneous coating, it is necessary that the product injected benefit from a perfect balance between its homogeneity, its potential of diffusion in filled spaces, and of course, its harmlessness. The author avoids the use of permanent fillers as there is too high a risk of complications, and if surgical rhinoplasty is performed after such injections, the surgery can become much more difficult and prone to complications. Among the many fillers available, the author’s choice
has gradually settled on hyaluronic acid, which can be safely injected in all areas; at the same time on the fixed level of the nose, but also at the level of the nasal point where cutaneous tension is very important and where the tolerance of the product must be optimal6, 7
. The
product must be of a constitution that has high reticulation for a stable result. It is necessary to use products which have a very high tolerance and safety profile (e.g. XHA-3, Laboratoires Filorga).
Figure 7 Anatomic preparation; the bone and cartilaginous nose: T=triangular cartilage, A=alar cartilage 42 ❚ September 2011 |
prime-journal.com
The injection technique Ideally, the procedure is made after the application of anaesthetic. It can, however, be carried out without any anaesthesia. The nasal point is the most significant part of the treatment. It is necessary, therefore, to draw up a robust plan of treatment before starting to inject (Figure 10). Indeed, the nasal cutaneous tension — in particular on the level of the point — is such that if too many injections are carried out, the product tends to be extruded. A number of treatment procedures can be followed, some of which are outlined below.
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