Injection rhinoplasty: non-surgical nasal augmentation and correction of post-rhinoplasty contour asymmetries with hyaluronic acid: how we do it.

Dear Editor, Rhinoplasty is technically demanding surgery, and even in the best of hands, postoperative healing and ultimate aesthetic outcome can be unpredictable. In addition to the risks of general anaesthesia, and a protracted postoperative convalescence, rhinoplasty may lead to adverse cosmetic sequelae of pollybeak deformity, over reduction of the bony or cartilaginous dorsum, inverted V deformity, alar retraction, supratip depression and bossae. Patients may also have functional complaints secondary to iatrogenic nasal valve disruption. Even in patients with an initial satisfactory outcome, slight asymmetries, depressions and contour irregularities may present several years after surgery. Despite these risks, cosmetic rhinoplasty is increasingly popular. A recent survey of UK cosmetic practice by members by the British association of aesthetic plastic surgeons, found that rhinoplasty accounted for 9% of all cosmetic surgery in 2008, and 23% of all male cosmetic surgery. The refinement of techniques to restore facial volume with dermal fillers, and widely available botulinum injections to treat dynamic facial rhytids, has led to a surge in demand for non-surgical rejuvenation procedures. An increasingly well informed and discerning patient population now seek better value procedures that require minimal downtime and have instant results. Discreet volumetric changes in the fronto-nasal angle, nasal dorsum and nasolabial angle lead to significant differences in our perception of the nasal aesthetic. These areas can be injected with dermal fillers to rejuvenate the nasal profile and correct asymmetries.