Noses. Officially the one area to treat that has always slightly terrified me. I think this probably stems from all those vascular occlusion horror stories that pop up on various professional forums and at conferences. As a result I’d always put noses in the category of ‘one day, when I’m more experienced’.
As it happens ‘one day’ finally arrived this week, and after injecting dermal fillers into just about every other part of the face, it was time to tackle my first nose. Luckily I was injecting under the watchful eye of an experienced trainer.
Having checked the patient’s medical history, consented them and taken multiple photographs I thoroughly prepped the patient’s skin. The patient was hoping to disguise a small dorsal hump and elevate and project the tip of the nose.
I carefully injected dermal filler in the midline above and below the dorsal hump using a needle. As the blood vessels are more superficial in the mid-line of the nose it is safer to inject in a deep tissue plane.
I then used a 27 gauge cannula (the brown tip one) to place filler into the nasal tip and either side of the mid-line.
At the tip of the nose the soft tissues are more tightly bound. This means there is less room for expansion and thus the risk of vascular compression more significant. Because of this I injected even smaller amounts into the tip than I had further up the nose. I also massaged the nose after each injection. This enabled me to shape the filler, check capillary refill was adequate and assess the firmness of the soft tissue. It’s important to note that the technique for massaging in the nose differs from other parts of the face. Finally I injected small superficial (in the dermis) linear threads of filler along the dorsum in the mid-line. This created a straight point of light reflection and is a beautiful finishing touch.
I was surprised to find that the initial 0.25ml made the most difference, with the subsequent filler making less of a noticeable impact. Caution might have meant I stopped as soon as an appreciable improvement in the nose was visible. However my trainer advised that, for longevity, a little more product is needed as some of this initial improvement is related to swelling which will subside in a week or two. Adding volume in small amounts is advisable with constant checking of the skin firmness (checked by squeezing/massaging the skin) to see build up of pressure. By the time we had finished I’d only injected around half of the 1ml syringe. It’s important to note the maximum volume of filler that can be safely injected in one sitting varies between individuals. Lastly, with the needle I injected very superficially within the dermis. This created a line of definition in the midline, further improving light reflection and the aesthetics of the nose.
The remaining filler was used to enhance the chin as improving the nose: chin ratio can do wonders for someones overall aesthetics.
Seeing the patient’s reaction when she looked in the mirror was amazing however my healthy respect for this area remains. Adding NSR to your treatment portfolio shouldn’t be a big decision providing you are trained. The best cases to start on are simple dorsal bumps, avoiding those with a previous history of trauma or surgical rhinoplasty. The video above is my first supervised case.