Fig. 1.

Case 1—to elevate low dorsum and increase tip definition. A, Pretreatment profile view of a healthy 38-year-old woman requesting a reduction of her bulbous tip. She rejected augmentation surgery because she considered that her nose was already too big and had no previous nasal trauma or surgery. B and C, There was a considerable difference in skin thickness when comparing the tip (B) and dorsum (C). Reduction surgery was thus considered to be contraindicated, and the patient agreed to try HA injection instead. Immediately after injection of 0.8 mL Restylane Perlane in the tip (0.15 mL intradermally with a sharp 29-G needle) and dorsum (0.25 mL intradermally with a sharp 29-G needle; 0.4 mL subcutaneously with a blunt 25-G cannula), the patient was positively surprised to find that her nose looked smaller as a result of the injection. D, Two years after the last of 3 injections (2.1 mL in total), the patient said that she had been satisfied with the effect but now considered that most had disappeared. However, after reviewing the before and after pictures, she was impressed to see that the effect actually still persisted and that the difference in appearance at 2 years after the last injection was relatively small compared with immediately after the injection.