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Injectables serve as nonsurgical option for beautifying the nose

International report — Injectables do not replace rhinoplasty, but they offer a viable alternative for those interested in nasal reshaping who are unwilling to undergo surgery, say Vince Bertucci, M.D., and Jean-Franois Tremblay, M.D.

Dr. Bertucci
"With careful patient selection and proper technique incorporating knowledge of anatomy, treatment with fillers or botulinum toxin can produce satisfying aesthetic results with acceptable safety and less downtime and cost than rhinoplasty," says Dr. Bertucci, consultant dermatologist, Women's College Hospital, Toronto, and medical director, Bertucci MedSpa, Woodbridge, Ontario.

Indications, evaluation

Nonsurgical nose reshaping with fillers can address minor deformities, including insufficient projection of the nasal tip, flattening of the nasal root, humps and bumps, and concavities, but it cannot correct more significant bony and cartilaginous abnormalities. Injections of botulinum toxin can help to minimize the appearance of nasal expression lines such as transverse rhytids between the brows and nasal "bunny lines," as well as to reduce alar flare and nasal tip droop.

Dr. Tremblay describes a systematic approach for assessing patients seeking nasal reshaping with injectables. The first step involves asking patients what bothers them so that the physician can understand their dislikes and expectations.

Dr. Tremblay
"Letting patients talk for a few minutes will give you a perception of their notion of an ideal nose and help to identify whether they have body dysmorphic thoughts. Among patients having body dysmorphic issues, the rate of cosmetic complaints about the nose is higher than for any other part of the anatomy," says Dr. Tremblay, associate professor of dermatology, University of Montreal, Quebec, and medical director, MdIME Aesthetic Clinique, Montreal.

The next step is to get an overall picture of the nose in terms of obvious irregularities, skin quality, color and thickness, and general shape, including asymmetry issues, size and concordance with the rest of the facial features.

"The ideal nose cannot be defined for any given individual without taking into consideration the rest of the facial features. The nose should be well-balanced and harmonious with the rest of the face, but the perception of the ideal nose also depends on gender, and there are cultural variations," Dr. Tremblay says.

An examination should be done from a frontal view; laterally to assess projection; and from a basal view that helps to understand facial anomalies underlying the features requiring correction.

Next, physicians should validate their first impressions against aesthetic standards for various parameters, including the size of the nose relative to the rest of the face, the alar and bony base widths, amount of columellar show, the relationship of the lips to the nasomental line and the sizes of the mentocervical, nasofrontal and nasolabial angles.

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