| RHINOPLASTY | ARtiCLe
Filling the hump The needle is introduced at an obliqueness of 45° until contact with the osseous is made. The needle should be held in the dominant hand. The thumb and the index finger of the other hand should apply a pressure to the side walls of the clean bones to prevent the product from diffusing laterally. This accidental diffusion of the product can spread to the level of the ocular ring and tear valley, and therefore must be prevented. It is sometimes necessary to fill the frontal nasal angle via a side access to perfect the treatment of this area. Once the product has been injected, it is set using careful massage.
Definition of the tip As discussed, it is necessary to avoid multiplying the injection points. One or two points of penetration are therefore carried out. They make it possible to distribute the whole of the product by emitting throughout the tip (treatment of the nasal point); the pressure of the injection is essential here. It is paramount to be slow and progressive to avoid any cutaneous damage, which can lead to necrosis.
Treatment of the columellar and opening of the nasolabial angle This treatment can be carried out when a treatment of botulinum toxin is not carried out at the same time. One deeply injects the product, which is deposited at contact with the nasal spine, to open the angle. The lines of columellar are then balanced more superficially.
The use of botulinum toxin Botulinum toxin A can be used for treatment of the nose, and only those varieties permitted for aesthetic use in each country, particularly: ■ Vistabel/Botox Cosmetic, derived from Botox, Allergan. It can be in packs of 50 or 100 U to be kept in the refrigerator between 2°C and 8°C ■ Azzalure, distributed in Europe by Galderma, directly derives from Dysport, Ipsen. It is moderately stronger than Botox, and comes in 125 U, which must be stored in a refrigerator between 2°C and 8°C. The different preparations are not interchangeable and
the specific units are diverse, just like their action in the tissues. The author generally recommends injecting at three
different sites (e.g. Figure 11 — overleaf): ■ Two injections of 2.5 U Vistabel or 5 U Azzalure in each elevator muscle of lip and nasal wing, parallel to the nasal wing (Figure 11a) ■ 5 U Vistabel or 10 U Azzalure at the nasal point (Figure 11b) ■ 5 U Vistabel or 15 U Azzalure at the level of the nasal spine divided into two planes; the first injection must be subcutaneous and the other deeply in contact with the bone (Figure 11c).
Protocol of treatment The protocol of treatment is standardised. The first procedure is carried out without over-correction,
Figure 9 Cross-section showing the vessels and nerves of the nose Botulinum
toxin A can be used for treatment of the nose, and only those varieties permitted for aesthetic use in each country.
Figure 8 The muscles of the nose
Figure 10 Example of treatment process and plan
prime-journal.com | September 2011
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