The Nonsurgical Rhinoplasty: A Retrospective Review of 5000 Treatments

We have read with great interest the article “The Nonsurgical Rhinoplasty: A Retrospective Review of 5000 Treatments,” recently published in the Journal by Harb and Brewster.1 The authors presented the experience of a single clinician performing nonsurgical rhinoplasty in the largest cohort to date, 5000 patients undergoing hyaluronic acid injection to correct a large number of aesthetic concerns. We would like to congratulate the authors on their article—the topic that they focused on is extremely important for all the surgeons dedicated to nonsurgical rhinoplasty—as well as on their surgical approach. We agree with the authors that nonsurgical rhinoplasty can be a highly satisfying treatment for both patient and clinician for primary correction as well as for postrhinoplasty sequelae that can easily be treated without surgery. In our experience, a patient’s nasal skin thickness is crucial to determine the cosmetic outcome of rhinoplasty and thus patient satisfaction. In our already-published study,2 we underlined that the thin-skinned patients who did not undergo camouflage of the nasal dorsum during surgical rhinoplasty were the most dissatisfied and underwent an increased number of secondary procedures. In thin-skinned patients, therefore, we must consider performing an ancillary procedure that covers the cartilage grafts and flaps in order to harmonize the results. Diced cartilage is one of the most widely used camouflage techniques in rhinoplasty, as first described by Peer in the 1943.3 When we did not preoperatively plan for camouflage of the dorsum in thin-skinned patients, we could observe contour deformities sometimes associated with loss of the continuity of the Shean-line dorsum. We present the case of a 35-year-old woman with a very thin envelope of the nasal region who had undergone primary closed rhinoplasty 7 years earlier. At that time, we had not yet begun performing dorsum camouflage during rhinoplasty. During the postoperative follow-up, we discussed with the patient the possibility of correcting the contour deformity with a surgical revision; the patient refused to undergo to a new operation, so we proposed a nonsurgical rhinoplasty. We infiltrated 1 cc of Juvederm Voluma Lidocaine (2 × 1 ml) (Allergan, Irvine, Calif.), with 0.1 cc at the radix of the nose, 0.5 cc at the dorsum site, 0.15 cc at the tip level, and 0.25 cc in the columellar region. With this technique, we restored the symmetry of the nasal region and achieved a satisfactory result for the patient and the surgeon (Fig. 1). We consider nonsurgical rhinoplasty to be a versatile tool after rhinoplasty as well, in thin-skinned patients who refuse to undergo revision surgery. [See Figure, Supplemental Digital Content 1, which shows 7-year postrhinoplasty result (above, left to right: frontal, oblique, profile, and basal views) and 2-month post–nonsurgical rhinoplasty result (below, left to right: frontal, oblique, profile, and basal views), https://links.lww.com/PRS/E621.]Fig. 1.: (Left) Seven-year postrhinoplasty result. (Right) Two months after nonsurgical rhinoplasty.PATIENT CONSENT Patient provided written consent for the use of her images. ACKNOWLEDGMENT Authors are members of the research group “To be and to appear: Objective indication to Plastic Surgery” of Campus Bio-Medico University of Rome, in Rome, Italy. DISCLOSURE The authors have no commercial associations that might pose or create a conflict of interest with information presented in this communication. No intramural or extramural funding supported any aspect of this work. Mauro Barone, M.D.Annalisa Cogliandro, M.D., Ph.D.Paolo Persichetti, M.D., Ph.D.Plastic and Reconstructive Surgery DepartmentCampus Bio-Medico University of RomeRome, Italy