Techniques
It is important to capitalize on the advantages of dermal filler and thread. The Gunter line (double aesthetic lines, Figure 1) is visible in the frontal view of the face. Providing volume along this line enhances the nose bridge from the frontal view. Suture material is placed along the Gunter line. Asians have a thicker nasal dorsum which is ideal for thread procedure. As the skin around the rhinion is very thin, it is safer to place short threads in the glabella and nasal tip separately, rather than use one thread along the line (marked in Figure 1). As shown in <Figure 2>, use a thin 1.5 cm thread of 31 gauge.
Figure 1. It is safer to use separate short threads in the glabella and nasal tip, rather than a long thread that connects the two areas.
Figure 2. Use a thin thread of 31 gauge, 1.5cm in length.
It helps to prevent the widening to create the overall line of the nose with a thread as described above in combination with dermal filler. <Figure 3> shows the insertion points for alae and dorsum line. Five 1.5 cm threads are inserted into one point for dorsum line correction and one 0.5cm thread is inserted each into five sites.
Figure 3. Entry points for alae and nose line correction.
I recommend beginners to use hyaluronic acid (HA) for dermal filler rhinoplasty. It is important to avoid injecting the filer into the blood vessels. <Figure 4> shows long needle and cannula techniques of filler injection as well as lateral and oblique injections using a short needle
Figure 4. Long needle and cannula injections of dermal filler vs. lateral injection and oblique injection using a short needle.
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Cautions during treatment
Botulinum toxin can also improve the outcome in combination with dermal filler and thread. As shown in <Figure 5>, four units of botulinum toxin can be used in the depressor septi nasi.muscle or 3-4 units in each of alae to lift the nasal tip and narrow the alae.
Figure 5. Inject four units in the depressor septi nasi.muscle or 3-4 units in each of the alae to effectively raise the nasal tip and reduce alae.
These techniques can be used to carry out successful rhinoplasty. However, doctors need to have a lot of experience and knowhow and perform physical examination of the patient before treatment. Practice caution during local anesthesia and injections to avoid blood vessels and minimize bruising. Patients need to be informed of the possibility of swelling after treatment.
The thread inserted along the Gunter line takes effect in two weeks. It is important to communicate with the patient the immediate effect of dermal filler and delayed effect of the thread.
The following procedure will have varying outcomes depending on the skill level of the doctor and patient characteristics. Innovative minimally invasive rhinoplasty techniques should be developed to satisfy a greater number of patients in the near future.
-To be continued
