Nose Filler: Types of fillers for non-surgical correction of the nose
They are both broken down naturally by the body and therefore are not a permanent treatment. Nose filler…
Types of fillers for non-surgical correction of the nose
The most popular NCR fillers are hyaluronic acid and calcium hydroxyapatite.
They are both broken down naturally by the body and therefore are not a permanent treatment. Hyaluronic acid has the added benefit of being reversible by hyaluronidase. That is, if an intra-arterial injection occurs or other problems arise, or even if the result is a little less desirable, this is quite correctable. Autologous fat, polymethyl methacrylate, and silicone are other, albeit less used, filler options. All of them can be considered constant to some extent. Permanent fillers should only be used after the patient and injector have had at least one “dress rehearsal” with a biodegradable filler.
When choosing a drug for NCR, it is important to consider the rheological properties of the filler. The first is the coefficient of elasticity (G’), which indicates the ability of the product to store mechanical energy and resist spillage or deformation when pressed. In general, the G’ coefficient increases with the amount of bonding of the hyaluronic acid molecules and can be considered as a measure of gel stiffness. Gels with higher G’s can better withstand dynamic force during facial muscle movement, thereby providing better potential lift and duration of filler effectiveness. However, these materials can be stiffer and lumpier, which can cause injury with pain, inflammation, and swelling as a complication after injection. Products with lower G’s tend to blend more easily with surrounding tissues, but may be less resistant to deformation than products with higher G’s.
The next non-rheological property to consider when choosing a filler is the hydrophilicity of the product. Molecules of real hyaluronic acid combine a huge amount of water and help the skin acquire elasticity and firmness. Injectable hyaluronic acids retain water in a similar way, with each filler manufacturer manipulating this property for different applications.
Thus, different hyaluronic acids on the market have different water retention capacity. In many cases, high hydrophilicity is considered a desirable effect, especially where a voluminous look is desired (such as on the lips). This, however, usually does not apply to the nose. Products that absorb less water are better for NSR, as they cause less tissue distortion and less chance of constricting vessels secondary to edema.
This allows you to change the product for its intended purpose. A recent publication from Switzerland confirms this concept. The authors of the article found that the addition of lidocaine to a number of well-known hyaluronic acid gels led to a change in the rheological properties of the gels.
They found that these modifications occurred to varying degrees depending on the gel, compared to test results obtained from studies without the addition of lidocaine.
An ideal NCR filler would be minimally hydrophilic, have high G’ and n* ratios, and be easily reversible. Currently, none of the injectables meets all of these criteria. Calcium hydroxyapatite is the closest, but not reversible. However, it is the “favorite” product for NHR by many article writers. CaHA may have superior longevity compared to HAJS suitable for nasal injection and this gives it a great advantage.
Autologous fat, polymethyl methacrylate, and silicone are all options for long-term and permanent NCR. Autologous fat, unlike other options, is plentiful and readily available. The fat is collected, centrifuged and prepared for injection. There is a possibility of changing the ability of fat grafts to survive and some absorption is inevitable leading to the need for repeat procedures. Various studies have reported graft retention rates ranging from 44.5% to <50% after 1-3 treatments. Other studies have shown good to high patient satisfaction >80%, but graft retention rates have not been established. This hints at the fact that other factors contribute to patient satisfaction, not just fat survival and graft viability. This would be an interesting topic for further research. Polymethyl methacrylate is a unique, long-lasting, possibly permanent filler consisting of PMMA microspheres suspended in bovine collagen. During its existence, it has undergone several transformations to reach the modern product called “Bellafill” from the manufacturer “Suneva”.
Rivkin reported in 2013 that it is a safe and effective remedy for correcting irregularities in the contour of the nose. A 2014 study comparing Artecoll, an early form of Bellafill with less uniform PMMA particle sizes, to a hyaluronic acid product as well as silicone found PMMA to be a superior filler. PMMA resulted in the fewest side effects and was able to maintain results 12 months after the procedure.
Silicone has been used for several decades as a soft tissue filler in general and also as a revision tool for postoperative rhinoplasty. Medical grade silicone is marketed by Alcon and approved by the US FDA for the treatment of retinal detachment. It is often misused for cosmetic purposes. Any use of nasal dermal fillers is currently considered “off label”. A 1986 report detailing the use of silicone for nose correction in 347 surgical rhinoplasty patients found it to be safe, effective, and a valuable adjunct to cosmetic rhinoplasty procedures.
Silicone has a reputation for being a high risk product due to its potential for foreign body rejection and granuloma growth. This has caused many doctors to stop using it. It is important to remember that many reports do not differentiate between medical grade silicone and industrial grade silicone. One example is a report of a cosmetic enhancement of the hip and buttocks through silicone injections performed in a local hotel room by non-medical staff resulting in disfigurement of the granulomas. Thus, it is not clear how many of these problems are related to a contaminated product or illegal medical practice and how they differ from the result with a valid, sterile and legal silicone product. However, foreign body reactions and granulomas are possible with any injectable implant, temporary or permanent. Injectors must be aware of this and apply appropriate treatment protocols.
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