What the Nose Needs to Know About Injectables

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While surgery (rhinoplasty) remains the gold standard for aesthetic improvement of the nose, both patients and physicians are constantly looking at alternatives that are non-surgical in nature.  With regards to injectable fillers to improve the nasal profile, further studies must be done to determine their safety and efficacy.

 

Perhaps no other feature impacts the facial aesthetic as significantly as the nasal profile:  the central location of the nose often serves as a visual axis, and standards of beauty are often based on how the nose serves to balance the rest of the facial structures.

To achieve this perceived balance, plastic surgeons offer rhinoplasty procedures—to either reduce (reduction) or increase nasal volume (augmentation).  And while surgery remains the gold standard, both patients and physicians have been constantly exploring non-surgical or minimally invasive methods of improving the nasal profile.

For example, augmenting the dorsum or bridge of the nose traditionally entailed implants; and whether the material was natural (patient’s bone or cartilage), or synthetic (silicone, polyurethane), surgery was a necessary step for implantation. Injectable fillers, already being used in facial augmentation, are becoming quite popular as an alternative to surgery, as it is both time and cost effective.

However, while fillers to correct furrows and lines in the face have been established, their use in nasal augmentation remains limited. This can be attributed to numerous factors related to the differences in nasal anatomy:  The skin envelope around the nasal skeleton is tighter and less forgiving to any expansile forces generated by the injection of substances; injecting too little may result in minimal improvement, too much and the skin may rupture.  Similarly, the introduction of a viscous substance makes its distribution less predictable—there may be problems in controlling the final shape of the injected material, which can be aesthetically undesirable.

The search for an ideal injectable material for nasal augmentation has been going on for decades, and a 2017 journal article in Current Opinions on Otorhinolaryngologic Head and Neck Surgery reviews literature on the substances used for this procedure. The authors collated citations and journal articles related to injectables in nasal augmentation from 1980 to 2017, with a particular emphasis on the choice of material and the reported success (or failure) in their use.

The literature indicates that hyaluronic acid (brand name: Juvederm, among others) and calcium hydroxyapatite (Radiesse) are the most widely-used injectables for nasal augmentation. This popularity is attributed to favourable safety profiles that are though to lead to fewer complications. Other substances like silicone have now fallen out of favor because of a higher reported incidence for infection or foreign body reactions.

Similar to injectable filler use in other areas of the face, most of the reported adverse events are related to injection volume and technique—and these may happen regardless of the choice of material. The authors note the importance of a thorough knowledge of nasal anatomy, as well as proper injection technique as the best ways to prevent complications.

This simply highlights the need for a thorough discussion with your clinician prior to any clinical procedure. This procedure is less invasive in nature but complications can occur; ensuring patient informed consent and physician competence is a must.

 

Written By: Jay Martin, M.D.

 

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