Skip to main content

Advertisement

SpringerLink
Log in

Advancing the Era of Liquid Rhinoplasty: A Methodological Approach to Injection Protocols

  • Innovative Techniques
  • Rhinoplasty
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Liquid rhinoplasty, a non-surgical procedure using hyaluronic acid (HA) to reshape and refine the nose, has gained in popularity as an alternative to traditional surgical rhinoplasty although its results are not definitive. However, the lack of standardized injection protocols has raised concerns about treatment consistency and patient safety.

Objectives

In this article, the authors propose a systematic protocol for the most common indications of liquid rhinoplasty.

Methods

By adopting a standardized methodology, healthcare professionals can enhance patient safety, improve treatment consistency, and optimize patient satisfaction.

Results

The protocol includes standardized injection sites categorized as dorsal, paramedian, tip and endonasal injections. Specific injection areas are recommended for different nasal shapes such as droopy noses, dorsal humps, nasal saddle deformity, inverted V deformity, tip shape abnormalities, twisted noses, revision cases with dorsal irregularities, and internal nasal valve dysfunction. While variations in filler dosages may be necessary based on individual patient needs, a conservative approach is recommended to maintain natural-looking results and reduce the risk of complications.

Conclusions

The increase in non-surgical techniques for nasal refinement offers patients more options, and systematized injection protocols based on different nasal types provide a structured framework for liquid rhinoplasty.

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Harb A, Brewster CT (2020) The nonsurgical rhinoplasty: a retrospective review of 5000 treatments. Plast Reconstr Surg 145:661–667. https://doi.org/10.1097/PRS.0000000000006554

    Article  CAS  PubMed  Google Scholar 

  2. Radulesco T, Winter C, Kestemont P et al (2022) Liquid spreader grafts: internal nasal valve opening with hyaluronic acid. Aesthetic Plast Surg 46:2912–2916. https://doi.org/10.1007/s00266-022-02913-8

    Article  PubMed  Google Scholar 

  3. Radulesco T, Braccini F, Kestemont P et al (2022) A safe nonsurgical rhinoplasty procedure. Plast Reconstr Surg 150:83e–86e. https://doi.org/10.1097/PRS.0000000000009226

    Article  CAS  PubMed  Google Scholar 

  4. Sahan A, Tamer F (2017) Non-surgical minimally invasive rhinoplasty: tips and tricks from the perspective of a dermatologist. Acta Dermatovenerol Alp Pannonica Adriat. https://doi.org/10.15570/actaapa.2017.29

    Article  PubMed  Google Scholar 

  5. Radulesco T, De Bonnecaze G, Penicaud M et al (2021) Patient satisfaction after non-surgical rhinoplasty using hyaluronic acid: a literature review. Aesthetic Plast Surg. https://doi.org/10.1007/s00266-021-02182-x

    Article  PubMed  Google Scholar 

  6. Pavicic T, Webb KL, Frank K et al (2019) Arterial wall penetration forces in needles versus cannulas. Plast Reconstr Surg 143:504e–512e. https://doi.org/10.1097/PRS.0000000000005321

    Article  CAS  PubMed  Google Scholar 

  7. de Maio M (2021) MD CodesTM: a methodological approach to facial aesthetic treatment with injectable hyaluronic acid fillers. Aesthetic Plast Surg 45:690–709. https://doi.org/10.1007/s00266-020-01762-7

    Article  PubMed  Google Scholar 

  8. Redaelli A (2008) Medical rhinoplasty with hyaluronic acid and botulinum toxin A: a very simple and quite effective technique. J Cosmet Dermatol 7:210–220. https://doi.org/10.1111/j.1473-2165.2008.00391.x

    Article  PubMed  Google Scholar 

  9. de la Guardia C, Virno A, Musumeci M et al (2022) Rheologic and physicochemical characteristics of hyaluronic acid fillers: overview and relationship to product performance. Facial Plast Surg FPS 38:116–123. https://doi.org/10.1055/s-0041-1741560

    Article  CAS  PubMed  Google Scholar 

  10. Radulesco T, Penicaud M, Santini L et al (2017) The MiRa scale, a new standardised scale for evaluating nasal deformities before and after septorhinoplasty: a prospective study comparing patient satisfaction and the surgeon’s assessment. Clin Otolaryngol 42:1350–1357. https://doi.org/10.1111/coa.12885

    Article  CAS  PubMed  Google Scholar 

  11. Konior RJ (2006) The droopy nasal tip. Facial Plast Surg Clin N Am 14(291–299):v. https://doi.org/10.1016/j.fsc.2006.06.002

    Article  Google Scholar 

  12. de Maio M (2018) Myomodulation with Injectable Fillers: an innovative approach to addressing facial muscle movement. Aesthetic Plast Surg 42:798–814. https://doi.org/10.1007/s00266-018-1116-z

    Article  PubMed  PubMed Central  Google Scholar 

  13. Nazım C (2017) Commentary on 3D photogrammetric analysis of the nasal tip projection and derotation based on the nasal tip quadripod concept. Aesthetic Plast Surg 41:1164–1166. https://doi.org/10.1007/s00266-017-0870-7

    Article  PubMed  Google Scholar 

  14. Chiang C-A, Tan P-C, Zhou S-B (2023) A reinforced framework construction technique using unilateral auricular cartilage in Asian rhinoplasty to prevent long-term nasal tip drooping. J Plast Reconstr Aesthetic Surg JPRAS 85:134–142. https://doi.org/10.1016/j.bjps.2023.07.001

    Article  Google Scholar 

  15. Segreto F, Marangi GF, Cerbone V et al (2019) Nonsurgical rhinoplasty: a graft-based technique. Plast Reconstr Surg Glob Open 7:e2241. https://doi.org/10.1097/GOX.0000000000002241

    Article  PubMed  PubMed Central  Google Scholar 

  16. Wang F, Garza LA, Kang S, Varani J, Orringer JS, Fisher GJ, Voorhees JJ (2007) In vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin. Arch Dermatol 143:155–163. https://doi.org/10.1001/archderm.143.2.155. (PMID: 17309996)

    Article  CAS  PubMed  Google Scholar 

  17. Ogilvie P, Benouaiche L, Philipp-Dormston WG et al (2020) VYC-25L hyaluronic acid injectable gel is safe and effective for long-term restoration and creation of volume of the lower face. Aesthet Surg J 40:NP499–NP510. https://doi.org/10.1093/asj/sjaa013

    Article  PubMed  PubMed Central  Google Scholar 

  18. Beneduce N, Botter C, Coiante E et al (2023) The longevity of the nonsurgical rhinoplasty: a literature review. J Stomatol Oral Maxillofac Surg 124:101319. https://doi.org/10.1016/j.jormas.2022.10.018

    Article  PubMed  Google Scholar 

  19. Rohrich RJ, Novak M, Alleyne B, Bellamy J (2023) Five-principle and five-step liquid rhinoplasty. Plast Reconstr Surg 152(4):633e–636e. https://doi.org/10.1097/PRS.0000000000010162

    Article  CAS  PubMed  Google Scholar 

  20. Hall SS, Kontis TC (2023) Nonsurgical rhinoplasty. World J Otorhinolaryngol - Head Neck Surg 9:212–219. https://doi.org/10.1002/wjo2.104

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kassir R, Venkataram A, Malek A, Rao D (2021) Non-surgical rhinoplasty: the ascending technique and a 14-year retrospective study of 2130 cases. Aesthetic Plast Surg 45:1154–1168. https://doi.org/10.1007/s00266-020-02048-8

    Article  PubMed  Google Scholar 

  22. Chen Q, Liu Y, Fan D (2016) Serious vascular complications after nonsurgical rhinoplasty: a case report. Plast Reconstr Surg Glob Open 4:e683. https://doi.org/10.1097/GOX.0000000000000668

    Article  PubMed  PubMed Central  Google Scholar 

  23. Mortada H, Korb A, Mawdsley E et al (2023) The use of hyaluronic acid in non-surgical rhinoplasty: a systematic review of complications, clinical, and patient-reported outcomes. Aesthetic Plast Surg. https://doi.org/10.1007/s00266-023-03386-z

    Article  PubMed  Google Scholar 

  24. DeVictor S, Ong AA, Sherris DA (2021) Complications secondary to nonsurgical rhinoplasty: a systematic review and meta-analysis. Otolaryngol-Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg 165:611–616. https://doi.org/10.1177/0194599820987827

    Article  Google Scholar 

  25. Jolly R, Bhalla M, Zakir R, Joshi N (2021) Visual loss from dermal fillers. Eur J Ophthalmol 31:NP102–NP105. https://doi.org/10.1177/1120672119855856

    Article  PubMed  Google Scholar 

  26. Wollina U, Goldman A (2020) Facial vascular danger zones for filler injections. Dermatol Ther 33:e14285. https://doi.org/10.1111/dth.14285

    Article  PubMed  Google Scholar 

  27. Lu Y, Hong W-J, Luo C-E et al (2022) Vasculature of the nasal cartilage region related to filler injection. Aesthetic Plast Surg 46:2461–2468. https://doi.org/10.1007/s00266-022-02942-3

    Article  PubMed  Google Scholar 

  28. Ugradar S, Hoenig J (2019) Measurement of the force required by blunt-tipped microcannulas to perforate the facial artery. Ophthal Plast Reconstr Surg 35:444–446. https://doi.org/10.1097/IOP.0000000000001302

    Article  PubMed  Google Scholar 

  29. Magacho-Vieira FN, Alfertshofer MG, Cotofana S (2022) The deep columellar approach for liquid rhinoplasty - a case series of 511 procedures over 16 years. Facial Plast Surg Clin N Am 30:193–203. https://doi.org/10.1016/j.fsc.2022.01.005

    Article  Google Scholar 

  30. Mehta U, Fridirici Z (2019) Advanced techniques in nonsurgical rhinoplasty. Facial Plast Surg Clin N Am 27:355–365. https://doi.org/10.1016/j.fsc.2019.04.008

    Article  Google Scholar 

  31. Goodman GJ, Magnusson MR, Callan P et al (2022) Aspiration before tissue filler-an exercise in futility and unsafe practice. Aesthet Surg J 42:89–101. https://doi.org/10.1093/asj/sjab036

    Article  PubMed  Google Scholar 

  32. Lin F, Goodman GJ, Magnusson M et al (2022) Movement of the syringe during filler aspiration: an ultrasound study. Aesthet Surg J 42:1109–1116. https://doi.org/10.1093/asj/sjac032

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

None.

Funding

All authors have nothing to disclose. No funding was received for this article

Author information

Authors and Affiliations

  1. Aix Marseille Univ, APHM, CNRS, IUSTI, La Conception University Hospital, ENT-HNS Department, Marseille, France

    Thomas Radulesco, Dario Ebode & Justin Michel

Authors
  1. Thomas Radulesco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dario Ebode
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Justin Michel
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

TR contributed to writing–original draft, supervision, writing–review & editing. DE contributed to reviewing and data collection. JM contributed to validation, writing–review & editing

Corresponding author

Correspondence to Thomas Radulesco.

Ethics declarations

Conflict of interest

No conflict of interest. The authors declare that they have no conflicts of interest to disclose.

Human and Animals Participants

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

Patients provided written informed consent for the use of their images.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Radulesco, T., Ebode, D. & Michel, J. Advancing the Era of Liquid Rhinoplasty: A Methodological Approach to Injection Protocols. Aesth Plast Surg (2024). https://doi.org/10.1007/s00266-024-04025-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00266-024-04025-x

Keywords

Search

Navigation