Patient Satisfaction After Non-surgical Rhinoplasty Using Hyaluronic Acid: A Literature Review

Nonsurgical rhinoplasty using the hyaluronic acid filler VYC-25L: Safety and patient satisfaction in a retrospective analysis of 492 patients

BACKGROUND

Aesthetic treatment of the nose with hyaluronic acid (HA) fillers is increasingly popular but carries a small risk of major complications. Large patient cohorts are required to better understand this risk.

AIMS

To evaluate safety and patient satisfaction in a large series of nonsurgical rhinoplasty treatments with the HA filler, VYC-25L, in "real world" clinical practice.

METHODS

This was a retrospective analysis of consecutive adult patients undergoing nonsurgical rhinoplasty with VYC-25L by a single injector between January 2020 and July 2022. All patients received initial treatment (typically ~0.3-0.5 mL of filler) and touch-up at 4-6 weeks (~0.1-0.3 mL). Safety data were collected throughout a mean follow-up of 11.1 months. Patient satisfaction was assessed using the FACE-Q Satisfaction with Nose and Satisfaction with Outcome questionnaires.

RESULTS

A total of 492 patients were included (984 treatment sessions including touch-ups). Of these, 467 (94.9%) were female and the mean age was 30.0 years. All treatments were associated with early transient edema; other adverse events included bruising (n = 123; 25%), residual asymmetry (n = 18; 3.7%), and suspected localized vascular occlusion (n = 3; 0.6%). The latter cases were easily resolved with hyaluronidase injection plus oral steroid and aspirin. No patients experienced infection, necrosis, blindness, lumps, granuloma, or delayed-onset nodules. Mean Rasch-transformed FACE-Q scores were 90.2% for Satisfaction with Nose and 99.2% for Satisfaction with Outcome.

CONCLUSIONS

In a large cohort of patients treated in routine practice based on a systematic approach, nonsurgical rhinoplasty with VYC-25L was safe and effective.

Surgical rhinoplasty after prior hyaluronic acid based nose remodeling

BACKGROUND

Medical rhinoplasty by hyaluronic acid injection (HA) has become nowadays a common practice. The number of patients requesting surgical rhinoplasty and having already undergone one or more injections of HA is increasing. However, the literature lacks publications regarding the management of these patients.

OBJECTIVES

The aim of this study is to discuss the management of patients who have been treated with previous nasal HA injections and who seek surgical rhinoplasty, and elaborate a treatment protocol and algorithm to standardize surgical plans.

METHODS

We are reporting case studies based on our clinical experience. We also reviewed the literature to suggest perioperative management for rhinoplasty with previous HA injections.

RESULTS

Hyaluronidase injection preoperatively allows to carry out an accurate preoperative analysis of the nasal deformities to treat, in order to make an adapted treatment plan. Postoperative course is similar to other rhinoplasty cases without the use of this enzyme.

CONCLUSION

Hyaluronidase should be used in all patients with nasal injections of HA (unless contraindications), who are willing to undergo a surgical rhinoplasty. The operation can be undertaken at one-week interval as soon as the edema subsides and no further treatments are necessary.

Repairing the Nose after Failed Minimally Invasive Procedures

Minimally invasive nasal procedures can be aimed at treating both functional and cosmetic problems. These procedures include lateral nasal wall implants, dermal fillers, thread lifting, and radiofrequency ablation. Though increasingly popular, nasal surgeons have limited data to draw from when faced with operating in a nose that has been altered by these techniques. In this article, best practice recommendations are described based on the available data for each of the techniques.

Cocaine Nose Correction: A Nonsurgical Approach Using a Novel Hyaluronic Acid Filler

Background

The use of hyaluronic acid (HA) fillers for correcting nasal deformities offers an increasingly popular alternative to surgical rhinoplasty. However, this can sometimes be extremely challenging, for example, in patients with a permanent defect in the nasal septum secondary to chronic drug use.

Methods

We report a case in which nonsurgical intervention with a high G' HA filler was used therapeutically to improve the permanent nasal disfigurement of an individual with previous long-term drug use (now in remission).

Results

This approach led to high levels of patient satisfaction and empowerment in her personal and professional life. Despite the high risk in this case, only immediate minor complications were recorded, including temporary edema and ecchymoses, and these resolved spontaneously.

Conclusions

Nonsurgical treatment using an appropriate HA filler may offer a safe and effective option in selected patients with nasal deformities resulting from pathological conditions.

The longevity of the nonsurgical rhinoplasty: A literature review

INTRODUCTION

Non-surgical rhinoplasty is one of the terms used to describe the technique of injecting fillers into the nasal pyramid region for aesthetic, and sometimes functional, purposes. Although it is now an extremely popular practice, the techniques proposed and the products used are different. This inhomogeneity is also found regarding the treatment longevity.

METHOD

A literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). It was realized to collect information on this disputed topic. Pubmed/MEDLINE database was explored.

RESULTS

A total of 228 articles were extracted from the basic literature search. 81 of these were excluded based on the content of the title and abstract. All 147 remaining articles were submitted for full-reading. 49 of these were excluded because the injection product used by the authors was not a hyaluronic acid based filler; while 82 of these were excluded because they provided no indication regarding the longevity of the treatment. Of the 16 selected studies, according to six authors, the duration of treatment is therefore between 8 and 12 months. For all the others, instead, the results seem to last longer than this period. The longest time interval was 8 years.

DISCUSSION AND CONCLUSION

Establishing with certainty the longevity of non-surgical rhinoplasty seemed to be extremely complex. In the light of this discordant data seems to be essential to deepen the argument. A study using imaging techniques and/or standardized photographic material appears essential to further investigate this controversial topic.

Surgical Removal of Foreign Material by Suction Curettage After Injection Rhinoplasty: Patient-Reported Outcomes

BACKGROUND

Though generally safe, injection rhinoplasty with synthetic non-hyaluronic fillers may lead to various deformities, which impose a psychological burden on the patients. As the injected material is technically hard to be fully cleared in the nose, the surgery is primarily chosen to address the patients' psychological distress caused by injection. Unfortunately, there is a paucity of data regarding patient-reported outcomes of this procedure.

METHODS

From August of 2017 to June of 2021, the authors retrospectively reviewed all cases who underwent the foreign material removals by suction curettage after injection rhinoplasties. The relevant demographic, treatment characteristics and complication details were collected. The modified Rhinoplasty Outcome Evaluation (ROE) questionnaires were prospectively completed before and 6 months after the surgery.

RESULTS

Of the 46 patients, four cases developed minor surface irregularities on the nasal dorsum postoperatively; two cases who had recurrent nasal dorsum redness and swelling before the surgery still exhibited the redness with a less degree after the surgery; no patients needed secondary revision. There was a significant improvement in any of patient-reported outcomes at 6-month follow-up, relative to the preoperative baseline scores.

CONCLUSION

The injected foreign material in the nose could be effectively removed by suction curettage with minimal complications. The patients' satisfaction and quality of life, which was severely impaired preoperatively, could be significantly improved after the surgery.

LEVEL OF EVIDENCE IV

Therapeutic study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Liquid Spreader Grafts: Internal Nasal Valve Opening with Hyaluronic Acid

BACKGROUND

Nasal valve disorders frequently give rise to nasal obstruction. Dermal fillers could be used in the internal valve area to generate valve widening. The goal of this study was to report our "liquid spreader" procedure consisting in the injection of hyaluronic acid (HA) at the internal nasal valve in patients complaining of nasal obstruction.

METHODS

The procedure described in this paper is suitable for patients with unilateral or bilateral nasal obstruction related to architectural features resulting in narrowing of the internal nasal valve. HA is injected along the internal valve from a single entry point located at the anterior part of the internal valve, thus creating a volume which will induce nasal valve widening. Rhinomanometries and visual analog scales (VAS) regarding nasal obstruction were collected before and after the procedure.

RESULTS

Sixteen patients were enrolled (7 females). Mean age was 44 years (min=24 y-o, max=65 y-o). Thirteen presented nasal valve narrowing without septal deviation while 3 patients had high septal deviation. Before injection, mean nasal resistances were 3.4±5.6 sPa/mL (min=0.55, max=19.8). One month after injection, mean nasal resistances were 0.38±0.26 sPa/mL (min = 0.20, max = 0.85). The difference was statistically significant (p=0.049). VAS scores were improved with a trend back to baseline after 12 months.

CONCLUSIONS

The liquid spreader is a useful procedure that can be combined with non-surgical esthetic rhinoplasties. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Five-point liquid rhinoplasty: Results from a retrospective analysis of a novel standardized technique and considerations on safety

BACKGROUND

Nonsurgical aesthetic improvement of the nose with hyaluronic acid (HA) fillers is becoming increasingly popular but comes with important safety considerations.

AIMS

To assess the safety and effectiveness of the standardized "five-point liquid rhinoplasty" approach.

METHODS

This was a retrospective, single-center analysis of consecutive adult patients undergoing nonsurgical aesthetic treatment of the nose. All had one of the three main indications (insufficient nasal projection, nasal hump, or deep glabella) and were injected using HA fillers with high elastic modulus. Treatments were given using some or all of the injection points of the "five-point liquid rhinoplasty" technique: P1 (nasal tip, 0.2-0.3 ml supracartilaginous); P2 (nasal root, 0.1-0.2 ml supraperiostal); P3 (cartilaginous dorsum, 0.1-0.2 ml supracartilaginous/supraperiostal); P4 (subnasal, 0.1-0.2 ml supraperiostal); and P5 (nasal alar, 0.1-0.2 ml per side supraperiostal). The risk of complications was minimized by injecting deep and staying in the midline as far as possible.

RESULTS

Twenty patients were enrolled (n = 15 female [75%]; mean age: 37.8 ± 11.7 years). The mean volume of filler used was 0.66 ± 0.35 ml per patient. Nineteen subjects (95%) said they were "very satisfied" with results, and the physician was also "very satisfied" with outcomes in 19 patients (95%). Two individuals experienced hematoma, which was managed conservatively; there were no other significant complications.

CONCLUSIONS

The "five-point liquid rhinoplasty" is a simple and effective method designed to maximize safety. It offers a good alternative to surgery in selected patients.

PMMA-collagen Gel in Nonsurgical Rhinoplasty Defects: A Methodological Overview and 15-year Experience

Nonsurgical rhinoplasty (NSR) is an alternative to surgical rhinoplasty for patients who desire correction of mild-to-moderate aesthetic nasal defects but do not wish to undergo surgery due to concern about risks, recovery time, or cost. Although not a surrogate, NSR can be a more accessible and more precise modality for achieving aesthetic goals. Furthermore, for certain types of defects, the precision possible with filler injection versus surgery can make NSR the preferred procedure. In these instances, polymethylmethacrylate (PMMA)-collagen gel is a valuable tool for appropriate candidates due to its permanence and its favorable safety profile when injected appropriately.

Application of Nonsurgical Modalities in Improving Facial Aging

Objective. This review aims to summarize different kinds of applications of minimally invasive surgery in improving facial aging to provide a comprehensive and accurate introduction on the issue of esthetic treatment of facial skin. Overview. In the twentieth century, facial rejuvenation has become a new beauty trend. Facial cosmetology has entered a period of antiaging and rejuvenation therapies and microplastic surgery. The pursuit of beauty has promoted the development of minimally invasive plastic surgery. This review introduces the possible causes of facial aging and its related topics with a focus on facial injectable drugs, such as botulinum toxin, main filler materials (hyaluronic acid, calcium hydroxyapatite, poly L-lactic acid, collagen, autologous fat, and polymethyl methacrylate), and some current antiwrinkle technologies, such as thread lift and radiofrequency rhytidectomy. Conclusions. Despite the difference in mechanisms of action, each technique can address facial aging involving the loss of collagen, displacement and enlargement of fat, and muscle relaxation. Combinations of these treatments can provide patients with reasonable, comprehensive, and personalized treatment plans.