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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39 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY April 2018 • Volume 11 • Number 4 R E V I E W In the immediate post-procedure period, light local pain and ecchymosis in the entry point is expected. Edema and erythema have been observed up to 30 days post-procedure. RESULTS Among our patient sample, 41 of the 45 patients (91.1%) were women. The mean age of the patients was 38 years (22–69 years). The parameters used in this study were nasal length, nasal projection, columellar-labial angle, and frontal nasal angle. Based on the findings, the nasal length increased by an average of 0.1cm -0.5cm to +0.7cm) and the nasal projection increased by an average of 0.08cm (-0.3cm to +0.3cm). Additionally, the nasofrontal angle decreased by an average of 0.37 degrees, and the columellar-labial angle increased by an average of 5.97 degrees (Figure 11). Complications. Nasal filling can have the same adverse effects and complications as those associated with fillers injected into other sites (Table 1). Major complications associated with this procedure include infection, vascular impairment due to direct injection or local compression, and blindness. The nose is particularly sensitive, as its vascularization has anastomoses with branches of the internal carotid, such as the ophthalmic artery. In addition, many patients who seek nasal fillings want to correct small defects that have remained after previous surgical procedures (e.g., rhinoplasty or septoplasty). In a large majority of cases, this results in a change in the vascularization of the region and certain areas of fibrosis, which might make the hyaluronic acid procedure more difficult, and in some cases, lead to intravascular injection, especially in the area of the nasal tip. In our patient cohort, only one complication occurred. One patient reported a pustule with discrete pain that did not involve the entry point area. A fistula was diagnosed and treated with the extrusion of a small amount of the product that had remained in that area, which had made it difficult to close the entry point. DISCUSSION Procedural considerations. Adequate knowledge of the proper techniques and patient anatomy is essential for the practice of nonsurgical rhinoplasty. Being proficient in the handling of the nasal filling from the beginning to the end—from indication to the recognition of any complications—is essential FIGURE 9. The black dot marks the location of the puncture that is made with a 22-gauge needle in the central region of the nasal tip before intoducing the 22G cannula FIGURE 10. Insertion of the cannula into the nasal tip in order to reach the radix and rhinion TABLE 1. Possible complications of nasal filler procedures EARLY DELAYED Edema/redness Bruising/ecchymosis Allergic reaction (angioedema, anaphilaxis) Inflammatory nodules Non-inflammatory nodules Embolism with blindness Tissue necrosis Glanulomatous inflammation/foreign body reaction Nodules with erythematous or not Granuloma Migration of the implanted filler Scarring Asymmetry Before Before Before Before After After After After FIGURE 11. The nasofrontal and columellar-labial angles before and after nasal filler injections

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