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Hanging columella: is an overgrowth of the nasal septum causing an overly-protruding columella.14
Supratrochlear artery Dorsal nasal artery Angular artery Lateral nasal artery Columellar branch Superior labial branch
Inverted ‘V’ deformity: is also a post-operative appearance and is due to the detachment of the upper lateral cartilages from the nasal bones. This leads to the upside down ‘V’ deformity at the junction of the upper and middle third of the nose.14
Conclusion Non-surgical rhinoplasty is a viable option in the sub-section of patients that do not need a reduction rhinoplasty. Requiring minimal downtime, it is also a useful tool to correct late onset complications following surgery or to treat very minor defects. Achieving treatment goals with NSR requires an in-depth knowledge of nose anatomy and the arterial system.
Figure 4: The arterial anatomy of the nose
Common nasal deformities Tip rotation: refers to the tip position along an arc of rotation in the longitudinal field. An over-rotated tip has the tip rotated towards the nose, making it look perky and what many refer to as ‘Miss Piggy’. An under-rotated tip is rotated in the opposite direction and makes the nose look droopy and appear longer.14 Saddle nose deformity: refers to damage to the middle cartilaginous middle vault that can leave a deep depression and clear step between the bony upper third at the rhinion. The tip in the lower-third structure is supported by the arched alar cartilages, therefore, damage can leave a saddle-like depression between the two highpoints. Common causes of saddle nose deformity are trauma, over aggressive surgery, autoimmune disease and cocaine abuse.14 Tension nose deformity: is an overgrowth of the dorsal part of the nasal septum and can cause a high, narrow appearance of the nose. This overgrowth of the nasal bridge can cause an overprojection of the nose.14 Pollybeak deformity: is a ‘hooked’ appearance of the nose following surgery. This occurs when the bony dorsum has been reduced, but the mid-third has not been lowered to correspond and gives a classic ‘parrot’s beak’ shape to the lower two thirds of the nose.14 Retracted columella: is a common feature found in Asian noses and can be treated successfully with NSR. When viewed laterally, if the columella is not visible by at least 2mm it is deemed to be retracted. It is associated with mid-face hypoplasia and can be caused by over aggressive surgery, trauma or birth defect.14 Pinched lobule: is due to over aggressive treatment of the alar cartilages either by over trimming or over tightening of the sutures in this area, which can cause the domes of the alar cartilages to collapse leaving a pinched nose.14
This article is the first of two on non-surgical rhinoplasty by Mr Geoffrey Mullan and Mr Ben Hunter. Their next article will detail techniques and complications and how to best manage these. Mr Geoffrey Mullan is a cosmetic surgeon and medical director at Medicetics Clinics and Training Academy. He has taught anatomy at Guy’s Hospital and worked at the Royal Marsden Head and Neck Unit, with an advanced understanding of the deep structures of the face. He has been a dermal filler trainer for Allergan and offers workshops in a number of treatments in central London. Mr Ben Hunter is a consultant facial plastic surgeon with extensive experience and expertise in nasal surgery. He works at St George’s Hospital Medical School, and privately at the Lister Hospital, Chelsea and King Edward VII Hospital in London. Mr Hunter qualified with the Royal College of Surgeons of England and holds European Board Certification in Facial Plastic and Reconstructive Surgery. He runs training workshops alongside Mr Mullan and a number of other faculties in central London. REFERENCES 1. Angelos PC1, Been MJ, Toriumi DM, ‘Contemporary review of rhinoplasty’, Arch Facial Plast Surg, 14(4) (2012), pp.238-47. 2. Moss R, ‘Cosmetic Surgery On The Rise, With 51,000 Brits Undergoing Procedures Last Year’, Huffington Post, (2016),<http://www.huffingtonpost.co.uk/2016/02/08/cosmetic-surgery-rising-inbritain-2015-statistics_n_9185180.html> 3. Adamson PA1, Warner J, Becker D, Romo TJ 3rd, Toriumi DM., ‘Revision rhinoplasty: panel discussion, controversies, and techniques’, Facial Plast Surg Clin North Am., 22(1) (2014), pp.57-96. 4. Pontius AT1, Chaiet SR, Williams EF 3rd., ‘Midface injectable fillers: have they replaced midface surgery?’, Facial Plast Surg Clin North Am., 21(2) (2013), pp.229-39. 5. Jasin ME1., ‘Nonsurgical rhinoplasty using dermal fillers’, Facial Plast Surg Clin North Am., 21(2) (2013), pp.241-52. 6. Jasin ME1., ‘Nonsurgical rhinoplasty using dermal fillers’, Facial Plast Surg Clin North Am., 21(2) (2013), pp.241-52. 7. Schuster B1, ‘Injection Rhinoplasty with Hyaluronic Acid and Calcium Hydroxyapatite: A Retrospective Survey Investigating Outcome and Complication Rates.’, 8. Nasal Anatomy emedicine.medscape.com/article/835134-overview Edward W Chang, MD, DDS, FACS Consulting Staff, Department of Cosmetic Services, Head and Neck Surgery, Kaiser Permanente of Northern California at Santa Rosa 9. Adamson PA1, Warner J, Becker D, Romo TJ 3rd, Toriumi DM., ‘Revision rhinoplasty: panel discussion, controversies, and techniques’, Facial Plast Surg Clin North Am., 22(1) (2014), pp.57-96. 10. Tezel A, Fredrickson GH., ‘The science of hyaluronic acid dermal fillers’, J Cosmet Laser Ther.,10 (2008), pp.35-42. 11. Hirsch RJ, Brody HJ, Carruthers JD., ‘Hyaluronidase in the office: a necessity for every dermasurgeon that injects hyaluronic acid’, J Cosmet Laser Ther., 9 (2007), pp.182-185. 12. Smith KC1, ‘Reversible vs. nonreversible fillers in facial aesthetics: concerns and considerations’, Dermatol Online J., 15;14(8) (2008), p.3. 13. Leong, S.C. and Eccles, R., ‘A systematic review of the nasal index and the significance of the shape and size of the nose in rhinology’, Clinical Otolaryngology, 34 (2009), pp.191-198. 14. Papel et al., ‘Facial Plastic and Reconstructive Surgery’ Third edition Thieme.
Bulbous tip: occurs if the alar cartilages are very broad and arched, a cupping depression between the cartilage and the caudal position of the middle cartilage develops.14
Reproduced from Aesthetics | Volume 4/Issue 1 - December 2016