PROMOTION
NON-SURGICAL RHINOPLASTY WITH PERFECTHA DEEP FILLER
Ayman El Attar discusses non-surgical rhinoplasty with a hyaluronic acid filler, paying particular attention to issues of anatomy, technique, and the overall benefits of such treatment
R
AYMAN EL ATTAR, MD, ABLS, ABFM, is the founder of Derma Laser Centers of New Jersey, USA, and a triple board certified physician and surgeon by the American Board of Family Practice, the American Board of Laser Surgery, and the American Academy of Aesthetic Medicine.
HINOPLASTY IS A TECHNICALLY demanding surgical procedure, and even in the best of hands, postoperative healing and ultimate aesthetic outcome can be unpredictable. As a
result, cosmetic rhinoplasty has become increasingly popular. Discreet volumetric changes in the fronto-nasal angle, nasal dorsum and nasolabial angle lead to significant differences in our perception of the nasal aesthetic. These areas can be injected with the hyaluronic acid (HA)-based Perfectha® Deep filler to improve the nasal profile and correct asymmetries.
Anatomy The nose is composed of skin, subcutaneous tissue, nasal mucosa, cartilage, and bone. The upper third is composed of the nasal bones, the middle third is composed of the nasal septum and the upper lateral cartilages, and the lower third encompasses the lower lateral cartilages and the caudal aspect of the cartilaginous septum. The midline septal cartilage provides underlying support to the lower two thirds of the nose. While this is the basic anatomic framework, variations and asymmetry are present in many individuals.
The nasal bones vary in thickness and width from the nasofrontal suture line cephalically to the end of the nasal bones caudally. They are thick and widest at the nasofrontal suture, narrow at the nasofrontal angle before they widen, and become thinner approximately 9–12 mm below the nasofrontal angle. These anatomic variations in thickness and width are important to
remember when HA injections are planned. The thickness of the soft tissue and skin of the nose
also varies at different anatomic points. The skin and soft tissue covering the nasal skeleton is thickest in the supratip region, while it is thinnest at the bony cartilaginous junction of the nasal dorsum. These variations affect the final nasal contour and profile after nasal augmentation.
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Technique Standardised pre-treatment frontal, lateral and 45° view photographs are taken. The patient should be in a semi-recumbent position and local anaesthetic with Lidocaine may applied to the entry point at the nasal tip. An appropriate cannula is first selected to administer the filler. In this study, the author used a 27 G 5 cm blunt cannula. The smallest cannula that the product will flow smoothly through is preferable because a thin cannula minimises patient discomfort and maximises the result. Perfectha® Deep is injected in the subcutaneous plane just superficial to perichondrium or periosteum following aspiration to prevent inadvertent arterial embolisation. Radix and upper nasal third injections should be medially placed to avoid the dorsal and lateral nasal arteries. Pre-injection palpation may aid identification, and aspiration before injection is mandatory. The cannula is kept in the midline to avoid the nasal vessels that run lateral to the midline. The cannula maybe placed in two directions, first directed
March 2013 |
prime-journal.com
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