E-lysium Skynn Rays Intl.

Aesthetics Skincare Institute

Nose fillers Injection Technique

Nose reshaping, often inappropriately referred to as the ‘non-surgical rhinoplasty’, is one of the
procedures where good outcomes are more difficult to achieve when using dermal fillers alone
The alternative has usually been to perform a conventional surgical rhinoplasty and to use the
fillers for the fine-tuning of any residual contour defects

More recently though when considering the shape and harmony of the facial features there is an
increasing trend to use only fillers for both nose and chin

Advanced fillers (typically the newer generation of cross linked hyaluronic acid based fillers) are
the first choice among fillers for the correction of the nose profile due to their softness, duration
and natural results with final complete reabsorption

Anatomy
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The nose triangle is the middle of the face where a little modification can create a significant
change in appearance It is useful in this context to regard the nose as a system of two
interrelated layers We are interested in the outer layer, which like a knitted elastic sleeve, slides
over the entire investing nasal subcutaneous tissues plus alar cartilages and their associated
lining

What are nose fillers?

Nose fillers are a non-surgical solution to help make the nose look smaller, narrower or to
correct a bump on the nose By using hyaluronic acid injections at strategic points, we can
narrow the nose bridge, decrease the nostril size and streamline the overall shape of the nose for
a flattering appearance, without any surgery or downtime needed

How to make a nose look smaller with dermal filler for nose

Faces are perceived by how light reflects off the surface of the skin When performed by a highly-
skilled practitioner, filler can be gently placed on the bridge of your nose, tracing the areas where
light reflects off it the most A non-surgical nose job can nicely narrow the nose bridge, creating
a smaller appearance
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Correcting nose asymmetry with nose bridge filler

We can rebalance the shape of the nose and correct asymmetry by placing dermal filler at
strategic points across a misshapen nose The lower part of the nose can often appear as
asymmetrical because of bumps, dents or dips But these can be recontoured and reshaped with
nose fillers when performed by an experienced clinician Additionally, nostril size can be reduced
by injecting dermal filler in the corners of the nose

AESTHETICS PROCEDURES / TECHNIQUES

Prior to treatment, the patient should be fully assessed and informed of the risks, complications
and expectations, and an informed consent obtained to perform the procedure Of note, point
out any pre-existing asymmetries, advise patients that specific cheek lines or smile lines may not
completely disappear following treatment and discuss the procedure, anaesthesia (local
infiltration or regional nerve block) and any potential adverse effects Ensure good, standardised
before and after pictures are taken

The subdermal / subcutaneous plane can be manipulated quite freely and painlessly Dermal
fillers should be injected using a retrograde linear threading technique involving fanning The
cannula or needle tip should remain in the skin whilst fanning (Although the recognised layer to
inject fillers in nose modulation is the supraperiosteal layer, this is present in the upper third of
the nose only, while the lower part has just smooth cartilage and heavy skin ) Each thread
injected should consist of 0 05-0 1ml and the total volume on each side will usually be between
0 5-1ml Following treatment, the skin is gently cleaned and gently massaged Appropriate
aftercare instructions must be provided, together with arrangements for a follow-up
appointment

For dorsum corrections, usually two or three points are injected directly on the dorsum, needle
directed at 45° from the dorsum, at supraperiosteal level with care being taken to aspirate before
and avoid large boluses Inject in small boluses only, less than 0 02mL per site
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The 25 mg/mL HA filler is commonly used , in all the cases, by using a syringe with a fixed
microneedle (30 G/8 mm)

Treatment strategy is based on the “3P Maneuvering” (Pinching, Pushing, and Pulling)

The capillary refill is checked (it should be less than 2 s) The Figure 1 shows the treatment
strategy

Inject at three key nose points with the following order: Tip; Columella; Radix and Dorsum

Tip: The syringe is inserted perpendicularly infusing the filler into the intercrural space of the
nasal lobule Total Maximum of 0 2 mL

First step: A pyramidal bolus (0 05–0 1 mL) is injected in the central point of maximum
projection

Second step: Two boluses (0 02–0 05 mL each) are injected cranially and caudally with respect
to the first one

Columella: Filler is injected deeply, at the base of the columella, with caudo-cranial access Total
Maximum of 0 3 mL

In order to achieve the rotation of the tip, one bolus (0 1–0 2 mL) is injected into the fibro-
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adipose tissue space in front of nasal spine

Afterward, two boluses of 0 02 mL each were administered, at a distance of 3 mm, along the
entire length of the columella in the intercrural space to give support and projection to the tip

Radix and Dorsum: Total maximum of 0 3 mL

A 0 1–0 2 mL bolus of the HA filler is injected perpendicularly to the level of the periosteum

Subsequently, two boluses (0 02 each) were injected at 3 mm from the first one in the cranio-
caudal direction

What Should I Avoid After Nose Fillers?

Directly After Your Treatment Avoid for at least 8 hours after your nose filler injections:

 Makeup

 Touching the injection site

 Pressing or massaging your nose

 Lying on/against the injection area (try to sleep on your back)

 To minimise the risk of bruising, it’s perfectly fine to lightly apply a covered ice pack to
the skin Just make sure it’s for no longer than 10 minutes at a time, and in 1-hour
intervals Do not apply ice directly to the skin and do not apply pressure

 Avoid for at least 24 hours following your nose filler treatment:

 Strenuous exercise

 Alcohol

 Avoid for at least 48 hours after nose fillers:

 Extreme heat (sun, solarium, sauna)

 Swimming
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 Applying excessive pressure to the injection area

 Avoid for at least 2 weeks after your nose filler treatment:

 Facials

 Facial waxing

 Peels

 Dermabrasion

 IPL or laser therapies

What happens during nonsurgical rhinoplasty?

During nonsurgical rhinoplasty, your healthcare provider may apply a topical anesthetic to numb
your skin Next, they’ll inject the dermal filler into specific areas on your nose to achieve the
desired results In some cases, your healthcare provider might use botulinum toxin injections
instead You might feel slight pressure or pinching during this process

The entire procedure usually takes 45 minutes or fewer

What happens after nonsurgical rhinoplasty?

Following nonsurgical rhinoplasty, most people experience minor side effects, such as redness
and sensitivity in the treatment area These symptoms usually only last a day or two

Additional side effects may include:

 Swelling

 Bruising
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 Nausea

 Migration (when the filler material migrates to other areas)

 Risks / Benefits

What are the advantages of nonsurgical rhinoplasty?

The most notable benefit of nonsurgical rhinoplasty is that many people can achieve desired
results without plastic surgery There are other advantages, too For example:

 The treatment takes less than one hour

 No downtime is necessary

 Results are immediate

 Changes are reversible

 There aren’t any incisions or scarring

Are nonsurgical nose jobs safe?

Any procedure carries risks But because your nose is vascular (filled with blood vessels) and
close to your eyes, nonsurgical rhinoplasty is more technical and complicated than other dermal
filler procedures
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A nonsurgical nose job should be performed by a licensed professional, such as a plastic

 Fever

 Blurred vision

 Increasing redness or swelling

 Vascular complications

 Tissue necrosis (death)

 Vision loss

 Recovery and Outlook

How long does recovery take?

No downtime is necessary after nonsurgical rhinoplasty You should be able to resume normal
activities right away

Your healthcare provider will give you specific instructions for managing any side effects

How long does a nonsurgical nose job last?

In most cases, nonsurgical nose jobs last about six months Depending on the type of dermal
filler used, results could last a bit longer

Is a nonsurgical nose job worth it?

It depends on your cosmetic goals If you’re wanting a subtle change in your appearance — and
you don’t need to improve the function of your nose — then a nonsurgical nose job may be right
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for you

However, if you want to make your nose smaller — or if you want to make major changes to your
nose’s structure — you may be better suited for traditional rhinoplasty

When to Call the Doctor

When should I see my healthcare provider?

 If you’ve recently had a nonsurgical nose job, call your healthcare provider right away if
you develop:

 Blurred vision

 Fever

 An allergic reaction, such as hives

 Redness or swelling that worsens after three days