Aesthetic nose correction: possibilities, risks, complications

Victoria Radkevich, angiosurgeon, dermatocosmetologist, specialist in injection techniques, leading methodologist at Callione Estet

Non-surgical rhinoplasty is a relatively popular procedure in aesthetic medicine, as the tip of the nose has always been a typical area of interest in surgery. According to the experience of many doctors, problems in this area can be successfully solved with the help of medical technology, which consists of using only hyaluronic acid to correct the nose. The present studies seek to illustrate this new technique and evaluate safety and outcomes.

Accepting the demand for nose correction, not every cosmetologist undertakes this type of procedure - due to the fact that there is a high risk of developing various kinds of complications. In this article, we want to propose techniques that minimize this risk, as well as describe clinical experience with the use of fillers for nose correction.

Introduction

There are two types of nose correction: surgical and medical. Surgical rhinoplasty is based on tissue reduction (chondrotomy, myotomy, osteotomy) and tissue augmentation (grafts), while medical rhinoplasty is based only on tissue augmentation techniques.

For many years, nose job has been a typical surgical technique that corrects many defects and enhances important facial characteristics. Due to its central location and harmonization with other areas of the face, the nose is an important aesthetic component. The ideal nose is one that most harmoniously matches other facial features. Although beauty cannot fit into standard templates, thanks to modern beauty correction capabilities, many people fall under the influence of the fashion trend - the craving for perfection. Every year, a large number of surgical procedures are performed to correct various aesthetic defects. Most patients are usually satisfied with the results.

But patients with minor nasal defects—due to anatomical problems or aging factors such as bone loss and age-related changes—usually do not want to undergo surgery. In such cases, simple contouring rhinoplasty techniques can be performed without any serious side effects. Defects in patients who have previously undergone surgery (secondary rhinoplasty) lend themselves well to contour correction with hyaluronic acid. The procedure can be repeated approximately once a year. It is simple and does not require rehabilitation time, as with surgery.

One of the best indicators of contour correction is a nose that is not too large and has a drooping tip. In these patients, the nasofrontal, nasodorsal, and nasolabial angles can be reduced. The success of this method depends on a well-corrected nasal tip. The technique is very simple and is based on the use of HA (26 mg/ml), which allows you to correct all minor defects. In recent years, the use of hyaluronic acid has been growing exponentially - given its easy use, biocompatibility, hypoallergenicity, and the ability to quickly correct any possible errors that may occur. Hyaluronic acid is widely used in aesthetic medicine and has proven to be an easy to process and safe substance. HA restores tissue turgor and plasticity.

There are many types of hyaluronic acid that are available in Ukraine. The work uses mainly HA of non-animal origin.

Features of the zone

The goal of medical rhinoplasty is to create a new harmony in the size of the nose, since a nose with balanced proportions appears smaller. Every doctor should know the main anatomical landmarks, risk zones and possible complications in order to avoid problems in the post-procedural period.

Let's start with anatomy. The most important muscles in this area are shown in Fig. 1.

Fig.1

The blood supply to the nose is very abundant and comes from the internal (upper) and external (lower) carotid arteries. The peculiarity of the blood supply indicates significant risks during injection correction (Fig. 2). The arteries connect on the back of the nose, forming a large number of anastomoses among themselves and, accordingly, between the systems of the internal and external carotid arteries. This determines the high risk of serious ischemic complications during nose contouring, especially in the dorsum.

Fig.2

Venous drainage from the nose occurs with the participation of the cavernous sinus. This makes it possible for the infection to spread from inflammatory foci of the external nose to the cavernous sinus and the development of severe orbital and intracranial complications (Fig. 3). The innervation diagram of the zone is shown in Fig. 4.

Fig.3,4

Aesthetic proportion and aesthetics of the nose

Many artists, including Leonardo da Vinci, at different times appreciated the aesthetically correct proportions of the human face. These divine proportions are good indicators in the search for proper nose correction and are especially helpful in understanding the actual results that can be achieved.

Aesthetic doctors usually divide the face horizontally into three zones:

• glabellar zone;
• zone from the glabellar to the dorsum of the nose;
• area from the back of the nose to its base.

Vertically, the face is divided into five equal segments from one ear to the other.

The ideal nose occupies the central part of the face in the horizontal and vertical plane, and this explains the great importance of the nose in the overall aesthetic harmony of the face.

The most important nasal angles help the specialist to achieve the most ideal proportion of the nose, taking into account the individual characteristics and wishes of each patient (Fig. 5-9).

Rice. 5-9

Indications and contraindications for the procedure

Indications for contour rhinoplasty may include:

• achieving the desired cosmetic effect;
• congenital pathology;
• nasal injuries;
• scars ;
• secondary rhinoplasty;
• violation of the shape of the nasal dorsum (humps, recesses, asymmetry, flattening of the dorsum, acute nasofrontal angle);
• violation of the shape of the tip of the nose (asymmetry, unevenness, bifurcation of the tip, drooping tip of the nose - acute nasolabial angle), mobility of the tip of the nose during facial expressions;
• violation of the shape of the wings of the nose (asymmetry, large lumen of the nostrils), excessive mobility of the wings of the nose.

Contraindications to the procedure:

• cardiovascular pathology, in particular coronary heart disease and arterial hypertension;
• diabetes mellitus - both types 1 and 2;
• oncological processes;
• pathology of the liver and kidneys;
• blood clotting disorder;
• inflammatory processes in the area of the planned surgical intervention, for example, folliculitis. Once the inflammation subsides, rhinoplasty is possible;
• patients under 18 years of age.

Recommendations before and after the procedure:

• it is necessary to stop taking aspirin and other drugs that affect blood clotting until correction;
• refrain from any physical activity after the procedure;
• sleep on your back;
• Avoid saunas, steam baths, and swimming pools for 2 weeks after surgery.

Possibilities of the technique

The procedure includes double treatment of the nasal area with an antiseptic (chlorhexidine 0.05%, exposure 2 minutes), conduction or application anesthesia and the actual correction of the nose using the chosen technique.

Possibilities of medical nose correction:

• change in nose length;
• correction of nasal protrusion;
• change in nasolabial angle;
• tip rotation;
• removal of the hump.

Read the full version of the article in the magazine Cosmetologist No. 3, 2016