Case Study: Non-Surgical Rhinoplasty

The non-surgical rhinoplasty is one of the most requested procedures in my practice. The increase in patient knowledge and awareness of non-surgical procedures, coupled with the advancement of dermal filler rheology and injection techniques, has led to a significant shift from surgical to non-surgical procedures. Having performed more than 1,000 non-surgical rhinoplasties, from simple cases to those that are more complex or even post-surgical, I have not only advanced my techniques, but have also witnessed the lifespan of the non-surgical rhinoplasty. I will be sharing a case study below. Case study A 21-year-old female presented in 2019, unhappy with the side profile of her nose. She had no history of previous non-surgical aesthetic procedures and no relevant medical history. She wanted the ‘bump’ softened, the nose to appear straighter and the tip to stop drooping, particularly when she smiled. The profile of the nose can be significantly enhanced using the non-surgical rhinoplasty, with very few exceptions. It is important to thoroughly assess numerous key anatomical features, such as the depth of the radix, the location of the dorsal hump and its relation to the glabella and the degree of nasal tip drooping on expression, to name a few. In this case, the patient presented with a very deep radix, a large dorsal hump, a flat and drooping nasal tip, little columella shows and an acute nasolabial angle. My approach The nose is not an area that needs ‘filling’ but rather requires a high-density dermal filler, which can support the areas to be augmented without requiring large volumes. Therefore, Stylage® XXL has been my product of choice for many years for this highly complex area of the face. The patented IPN-like technology of the product has created unique viscoelastic properties which allow it to

create excellent projection with minimal volume injected. Clinically, this is very important. When augmenting a deep radix, care has to be taken to avoid widening the nose and thus creating the undesired and unnatural ‘avatar’ look. The same principles apply when lifting the nasal Cosmetic dentist Dr Thuha Jabbar provides tip; good projection and elevation with as little volume as a non-surgical rhinoplasty case study using possible to avoid widening the tip. Again, this is achieved with ease using Stylage® XXL and in this case, despite its Stylage® XXL complexity, a total of 0.9ml was used. Given the need for precise product placement in the nose, I used a 30-gauge needle at four main anatomical points, in varying depths relative to the anatomy. I injected slowly and inserted small micro boluses of filler, until the desired, pre-planned Dr Thuha Jabbar is a cosmetic shape was achieved. I always start at the radix, followed by the anterior nasal spine and columella, middle crus, supratip lobule and dental surgeon and founder of upper lateral cartilages. Starting with the radix allows me to correct Almás Dentistry & Aesthetics. the dorsal hump. This is also the least uncomfortable area for the patient so a good place to start. The purpose of injecting the anterior nasal spine is to create additional support at the base of the nose, which in turn will do two things. Firstly, it will project the columella, thus enhancing the columella show and, secondly, it will also lift and support the tip, preventing it from drooping on expression. This is achieved by an element of myomodulation of the depressor septi muscle, eliminating the need for botulinum toxin. Augmenting the middle crus allows you to alter the shape and position of the nasal tip. Raising the tip higher contributes to the appearance of a shorter nasal bridge and sharpens the tip, contributing to a nose that appears slimmer and softer. Finally, to treat the lower portion of the nose and to soften any irregularities/asymmetries, I placed small linear threads along the cartilage plates. Sequalae The patient returned after 18 months to have the treatment repeated. It is very interesting to see that despite the duration, the nose had not returned to its original form and had indeed retained some of the non-surgical augmentations. This is the case in all the noses I re-treat. My approach for the re-treatment is identical to the initial approach and what I often find is that even less product is required, and the results are usually even better as you are starting with essentially a simpler nose. In this case, on the second visit, only 0.5ml of Stylage® XXL was used. Conclusion The non-surgical rhinoplasty, in my opinion, is by far the most rewarding and life-enhancing area of the face to treat. Given the Before After 18 months After second treatment ability to create surgical results, with little downtime and the option of reversibility, the procedure will continue to be in high demand. It is important for practitioners to equip themselves with the ability to correctly assess treatment plans and execute this delicate procedure to the highest of standards, utilising premium products that will allow practitioners to achieve excellence.

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