Journal of Clinical and Aesthetic Dermatology

APR 2018

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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36 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY April 2018 • Volume 11 • Number 4 R E V I E W N Nonsurgical rhinoplasty using hyaluronic acid is an effective technique for ameliorating nasal defects. It can be classified as primary, when the patient has had no previous procedures, or secondary, when used for corrections after surgical rhinoplasty. 1 Surgical nasal remodeling, which is the gold standard for correcting nasal defects, allows for precise improvements. 2 However, certain surgical procedures might be unsuitable for patients who are interested in the correction of small defects or desire improvements complementary to a previous surgical procedure. In these cases, the use of hyaluronic acid is a safe, less invasive, and less costly alternative to surgery that requires shorter recovery time and has less associated risks of complication. In both men and women, the nose is an essential feature when considering the aesthetic appeal of the face. 3 As aesthetic preferences vary from person to person, the concept of the "ideal" nose should be applied on a case- by-case basis, with respect to the classical patterns of anthropometry, sex, ethnic group, and psychosocial factors. 2 Morphology is not only restricted to the static quality of the nose but is directly related to the personality and preferences of the patient. When patients wish to correct or adjust lack of projection of the nasal tip, rectification of the back, or deviations of the septum, hyaluronic acid is an excellent alternative to surgical correction. ANATOMY The nose is a three-dimensional structure that, when dividing the face vertically into three sections, is located in the middle third of the face. When the face is divided horizontally into fifths, the nose is located in the middle fifth. It is composed of four structures: skin, cartilage, muscle, and bone. Its appearance is defined not only by rigid structures but also by the soft tissue. Topographically, the nose extends inferiorly from the forehead and can be divided into three sections. The upper third is formed by the nasal bones and the frontal process of the maxilla; the middle third by the lateral processes of the septal cartilage paired; and the lower third by the inferior nasal spine, part of the maxillary bone process, and by the larger wing cartilages A B S T R A C T The nose is an essential feature when considering the aesthetic appeal of the face. As aesthetic preferences vary from person to person, the concept of the "ideal" nose must be applied on a case-by- case basis, with respect to the classical patterns of anthropometry, sex, ethnic group, and psychosocial factors. Interest in less invasive procedures for nasal correction has increased considerably, among which is the emerging use of hyaluronic acid for nonsurgical rhinoplasty. In this article, the authors present an objective review of the anatomy of the nasal region, the evaluation and indications of nasal filling with hyaluronic acid, a description of the technique, and brief discussion of associated complications. KEYWORDS: Nasal filler, anthropometry, proportions, hyaluronic acid, nasal correction Evaluation and Proportion in Nasal Filling with Hyaluronic Acid by BRUNA SOUZA FELIX BRAVO, MD; LEONARDO GONÇALVES BRAVO, MD; CAMILA MARIANO DA ROCHA, MD; STEPHANIE BIANCO DE SOUZA, MD; FERNANDO LUIS LOPES, MD; and JULIEN TOTTI, MD Dr. B. Bravo is with the Institute of Dermatology of Professor Rubem David Azulay in Rio de Janeiro, Brazil. Dr. L. Bravo is Full member of the Brazilian society of plastic surgery, Plastic surgeon at Burn Center in Hospital Souza Aguiar Rio de Janeiro Plastic surgeon at federal Hospital servidores do estado do Rio de Janeiro. Dr. Mariano da Rocha is with the Federal University of Health Sciences of Porto Alegre in Porto Alegre, Brazil, and the Federal University of Rio de Janeiro in Rio de Janeiro, Brazil. Drs. De Souza and Lopes dos Santos are with Gamboa Hospital in Rio de Janeiro, Brazil. Dr. Totti de Bastos is with the Federal Hospital of Lagoa in Rio de Janeiro, Brazil. J Clin Aesthet Dermatol. 2018;11(4):36–40 FUNDING: No funding was provided for this article. DISCLOSURES: Dr. BSF Bravo reports that he is a speaker for Allergan. The other authors have no conflicts of interest relevant to the content of this article. CORRESPONDENCE: Bruna Souza Feliz Bravo, MD; Email: brunabravo@gmail.com

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