Table 2.

Experts’ Responses About Chronology With Which They Perform a Nonsurgical Rhinoplasty

Expert 1 (the Middle East and the Gulf region)	Expert 2 (Asia)	Expert 3 (Europe)	Expert 4 (South America)
- Apply lidocaine 15.6% anesthetic cream at the nasal tip and dorsum and wait for 10 min. - Inject the radix by multiple small boluses using a 29G needle inserted perpendicular to the nasal bone till reaching the desired radix level. - Puncture the nasal tip with a 27G needle at the junction between the upper third and lower two-third of the distance between the nasal tip and nasolabial junction. - Insert a 25G cannula vertically perpendicular to the nasal spine between the 2 medial sides of the lower lateral cartilages injecting while mildly compressing the columella between 2 fingers of the non-injecting hand to support the nasal tip. - Insert the cannula in the subdermis to the point where the nasal tip needs to be most prominent and inject a small bolus of filler. - If indicated, inject a bolus of fillers at the upper nasolabial fold triangle to support the alae using a 27G needle oriented perpendicularly and aspirating before injecting or using a 25G cannula along the nasolabial fold. - If indicated, inject botulinum toxin to the nasalis muscle and depressor septi. - If botulinum toxin is used, the nose is taped to keep the tip supported during the first 5 d.	Retrograde injection starting from the radix downward. Introduction of the cannula through the inferior nasal tip and gliding along the perichondrial plane. It is important not to over inject in the radix as most patients are not looking for a higher nasal take-off point. Over injection in this area will flatten the nasal projection.	A nasal gauze embedded with lidocaine cream and antiseptic is inserted in the nostrils for 5 min and then a 3-step technique is followed: 1. Injection at labiocolumellar angle in 3 incidences to reproduce a columellar strut for opening the labiocolumellar angle and getting more support to the nasal tip. 2. Injection to the upper one-third of the dorsum, between the superior border of the hump and the level of the nasofrontal angle (NFA) to hide the hump and create a straight line from the NFA to the dorsum 3. Injection to the tip of the nose to recreate the tip defining points as a tip graft. Injection by an intranasal approach.	- Cool sense device for anesthesia. - Injection of the selected areas using a 27-30G needle aspirating before injecting. - For the nasal tip, access the transcutaneous infra-tip in superior and anterior directions to the supra-cartilaginous mucosal plane. Possible injection sites are supra-tip, medial tip, or infra-tip. The tip is held between the thumb and index finger at the time of injection. - For the nasal dorsum, supra-periosteal or supra-cartilaginous plane at the upper port and transcutaneous at the osteocartilaginous junction. Microboluses or linear retrograde injection is used. The needle is directed at an angle of 90° in relation to the bone while holding the bony edges between the thumb and index finger. - For the columella, transcutaneous injections are made for definition. Supra-cartilaginous and supra-periosteal injections are used at the levels of the nasal tip and nasal spine, respectively. The injection is performed in a linear retrograde pattern. Columellar injections are performed while holding it between the thumb and index fingers. - Hemostasis by applying pressure or cold compresses. - Injection of botulinum toxin if required. - Monitoring the patient for at least 15 min in search of signs of possible ischemia secondary to treatment and immediate treatment with hyaluronidase if it occurs. - Posttreatment photographs. - Provide general recommendations and warning signs. - Telephone follow-up within 24 h.