Nonsurgical Rhinoplasty: Indications and Safety

Abstract

IntroductionThe desire for minimally invasive procedures is driven by the rise of posting “selfies” to social media, as well as the new virtual working environment with webcams. With the camera constantly on faces, the rise for injectables will only continue. Soft-tissue fillers are an efficient and successful way to provide a patient with increased self-esteem. Nonsurgical rhinoplasty is a common and desired procedure to augment the appearance of one's nose. Soft-tissue fillers have been found to be safe; however, there can be complications. Some are less severe, such as: edema, hypersensitivity reactions, erythema, and ecchymosis, while other complications can be more severe, such as: infection, granuloma formation, arterial occlusion or embolization, and blindness. Nonsurgical rhinoplasty poses higher risk, given the vasculature of the nose, which is why education on this type of injectable is vital. MethodsThe purpose of this study was to assess the predictability and safety of nonsurgical rhinoplasty procedures while reviewing the proper techniques for a successful procedure. The aim was toward those oral and maxillofacial surgeons who perform nonsurgical rhinoplasty in an outpatient setting. A 3-year retrospective assessment of clinical outcomes and adverse events was performed in patients who had nonsurgical rhinoplasty between January 1, 2018, and December 31, 2020, as outpatient procedures. ResultsA total of 163 patients (147 female and 16 male), aged 15-77 years old, underwent nonsurgical rhinoplasty between January 1, 2018, and December 31, 2020. The fillers used for treatment included: Belotero, Juvederm Ultra XC, Restylane-L, RHA2, and Dilute Radiesse. All patients were satisfied, and none of the patients reported major complications from the procedure. ConclusionThe use of soft-tissue fillers for nonsurgical rhinoplasty is a predictable and relatively safe procedure. However, some serious complications can arise. Injections in the perinasal region can lead to the risk of blindness due to retrograde travel of material in the ophthalmic artery to the choroid and retina. All perinasal injections should be made deep to the perichondrial plane on the midline and deep to the preperiosteal plane in the lateral nose. The infraorbital foramen is a key landmark when placing fillers. It is typically about one-third the distance between the medial and lateral canthi and 11mm below the infraorbital rim. Injections medial to the infraorbital foramen should be performed with caution in order to avoid the angular artery as well as the dorsal and lateral nasal arteries. When injecting in the lateral nose, the injection should be made at the midpoint of the dorsal aesthetic line and the nasofacial groove to avoid the previously mentioned arteries. These arteries create an anastomosis with the ophthalmic artery, which is the artery involved in the high-risk complication of blindness. Blindness can occur immediately, be delayed, or have late onset ranging from days to weeks after the procedure. Aspiration techniques are crucial as the nasal vasculature is shallow and branched. Providers must also know techniques and strategies to manage various complications in the event that they arise to provide patients with the best possible outcome for full recovery. Overall, nonsurgical rhinoplasty is a procedure that should be recommended to cosmetic patients, but caution must be taken to ensure safety and surgeons need to have proper training.