INTRODUCTION: Dermal filler applications in the nose are mainly performed in two indications: (a) total dorsal augmentation, (b) injections to certain areas for nonsurgical aesthetic corrections and camouflage or to cover defects such as postoperative irregularities or deviations.
In order to obtain aesthetic results, injections are generally applied to four regions: (1) radix, (2) supratip, (3) tip, and (4) nasal spine. Radix and supratip injections are mostly made for hump camouflage, and the rest are for tip rotation and projection.
In our study, we developed a hybrid treatment model by applying two different structural types of dermal fillers. We used fillers containing hyaluronic acid (HA), a hydrophilic material, in cases where definition was required for the nasal tip and augmentation in supratip region. Besides, in cases where augmentation was required for radix and elevation was required for nasal tip, we used fillers containing agarose gel, a non-hydrophilic (hydocolloid) and high G prime filler material, so that it does not cause an undesired expansion by swelling, which may disrupt the aesthetics of the nasal root or narrow the airway by widening of the columella.1
MATERIALS AND METHODS: A total of 32 woman patients (mean age 27 years) desiring filler treatment for non-surgical correction of nose in a 2-year period were enrolled in this study. Inclusion criteria consisted of patients who had not received any previous filler injections, threads, or surgery. A 3.5% agarose gel was mixed with 0.2 ml of 2% lidocaine, and the mixture was applied with 27 G needle to the radix and nasal spine by perpendicular supraperiosteal injection with small boluses. After radix and nasal spine injections, HA filler containing 20 mg HA with lidocaine was applied with 32 G needle for the tip defining points and supratip area by intradermal injection, if needed. The patients were seen two weeks after injection in order to see if there is any complications or misplacement or revisional “touch-up” needed. Follow-up visits were made on 1 and 6 months after the injection. Clinical improvement was evaluated by a different blinded plastic surgeons using the Global Aesthetic Improvement Scale from 1 to 5 (1: exceptional improvement; 2: very improved; 3: mild improvement; 4: unaltered patient; 5: worsened patient). Patient satisfaction was evaluated in a scale from 0 to 10 (0: not satisfied with results; 10: very satisfied)
RESULTS: Mean score of patient satisfaction was 9.09 of 10 after injection and 9 of 10 after 2 weeks. Clinical evaluation scores after injection were 1.72/5 and 169/5 in GAIS. No major complication was observed.
CONCLUSIONS: To our knowledge, this is the first study adopting the understanding of hybrid approach with a new agarose gel and HA filler in different anatomical locations for nonsurgical correction of nose. We can conclude that this HA and nonswelling agarose gel filler hybrid concept represents a great and safe option for nonsurgical rhinoplasty procedures.
REFERENCE:
1. Sánchez A, Bernárdez C. A new nonhydrophilic agarose gel as subdermal filler for facial rejuvenation: aesthetic results and patient satisfaction J Cosmet Dermatol. 2020;19(8):1900–1906.