| RHINOPLASTY | ARtiCLe References
1. Pech A, Cannoni A. La rhinoplastie personnalisée. Paris: Springer-Verlag, 1993
2. Braccini F, Porta P,
Thomassin JM. “Mini- rhinoplasty”. Rev Laryngol Otol Rhinol (Bord) 2006; 127(1–2): 23–8
3. Braccini F, Saban Y, Canale H, Erena H. Mon nouveau nez. France: Editions du Losange, 2006
4. Anderson JR, Ries WR. Rhinoplasty: emphasizing the external approach. The American Academy of Facial Plastic and Reconstructive Surgery. New York: Thieme Inc, 1986
5. Redealli A, Braccini F. In first instance, the camouflage of osteocartilaginous
kyphosis is paramount. The treatment of the point and filling of contact angles with the lip or the face can provide remarkable results.
Botulinum toxin The control of mimical facial wrinkles using botulinum toxin A is currently a well-known process, even in all ‘off-label’ uses, but its use at the level of the nasal muscles is a more recently described process9, 10
. This new therapeutic target presently opens a wide
application area and, relying on the more general concept that includes facial rejuvenation, it plans for the use of small doses of botulinum toxin on a regular basis. This use of botulinum toxin into the nasal muscles is an approach that should be considered complementary to the use of a filler.
The contraindications Fillers The contraindications related to the particular product and any technical information produced by the manufacturer should be noted. The author never uses a permanent filler and avoids those that are not hyaluronic acid-based. In addition, it is necessary to respect the contraindications specific to hyaluronic acid, such as the risk of cutaneous infection, and avoidance during pregnancy6, 7
. The psychological dimensions of nasal modification
must always be taken into account. Contraindications are directly related to the psychological and artistic analysis before therapy, and in certain cases, only the surgery will allow an adapted result, particularly in reduction rhinoplasty.
Botulinum toxin Contraindications to the use of botulinum toxin are allergy to the drug and infection or inflammation at the proposed injection site(s)9, 10
. Safety for use during
pregnancy or lactation has not yet been established. Therefore, it is prudent to avoid botulinum toxin therapy for elective procedures in women of childbearing age until absence of pregnancy or adequate contraception is assured. Relative contraindications include diseases of neuromuscular transmission, coagulopathy (including
prime-journal.com | September 2011 Case example two
Secondary rhinoplasty The patient has been operated on, and there is a residual hump (A). The medical treatment consist with HA injection (up and down) to hide the hump (B)
therapeutic anticoagulation), and inability of the patient to cooperate. In the more complex disorders, botulinum toxin therapy should not be used unless a skilled interdisciplinary team and sophisticated instrumentation are available to ensure valid diagnosis, state-of-the-art treatment, and appropriate follow-up9, 10
. The physician
administering this drug should be trained in its use and qualified to manage any complications.
Conclusions The soft rhinoplasty, or mini-rhinoplasty, is a very basic way in which to correct the nose in both safe and modern conditions. Medical rhinoplasty is a newer, minimally-invasive procedure, which is also temporary but with impressive outcomes. It is a remarkable procedure which provides surprising results with a stability greater than that of treatments to other parts of the face. For both procedures, technical training is paramount, and an artistic approach to the indications is necessary.
Declaration of interest none Dr Braccini is co-author of Medical Rhinoplasty: Basic Principles and Clinical Practice.
www.oeofirenze.it
Medical Rhinoplasty. Basic principles and clinical practice. Firenze: OEO, 2010
6. Braccini F, Dohan Ehrenfest
DM. Medical rhinoplasty: rationale for atraumatic nasal modelling using botulinum toxin and fillers. Rev Laryngol Otol Rhinol (Bord) 2008; 129(4–5): 233–8
7. Braccini F, Dohan Ehrenfest
DM. Advantages of combined therapies in cosmetic medicine for the treatment of face aging: botulinum toxin, fillers and mesotherapy. Rev Laryngol Otol Rhinol (Bord) 2010; 131(2): 89–95
8. Braccini F, Saban Y. Surgical anatomy of the nose. Rev Laryngol Otol Rhinol (Bord) 2006; 127(1–2): 9–13
9. Dayan SH, Kempiners JJ.
Treatment of the lower third of the nose and dynamic nasal tip ptosis with Botox. Plast Reconstr Surg 2005; 115(6): 1784–5
10.Braccini F, Berros P,
Belhaouari L. Botulinum toxin, description and clinical applications in the treatment of the face wrinkles. Rev Laryngol Otol Rhinol (Bord) 2006; 127(1–2): 105–11
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