Safe Planes for Injection Rhinoplasty: A Histological Analysis of Midline Longitudinal Sections of the Asian Nose

Overview

Building up the bridge with filler is central to non-surgical rhinoplasty in Asian patients, and injecting into an artery can cut off blood supply to the skin. The authors dissected the midline of the nose from the brow to the tip and examined the tissue under the microscope, using muscle and cartilage as landmarks.

Sections of note

• 135 histological cross sections from 45 longitudinal strips of midline nasal soft tissue, from the glabella to the tip.
• A midline columellar artery, diameter 0.21 mm plus or minus 0.09, was present in 14 of 45 cadavers (31.1 percent).
• Below the tip the tissue contained cavernous tissue with direct artery-to-vein connections, into which filler could be pushed backward.
• All nasal arteries found were subcutaneous, running mainly in the superficial layer with smaller branches forming networks under the skin.
• A substantial arterial junction was found at the supratip in 29 of 45 specimens (64.4 percent), diameters 0.4 to 0.9 mm, in the middle of the subcutaneous tissue.
• The same artery crossed the midline at the rhinion at 0.1 to 0.3 mm, judged too small to cause blockage. No significant arteries lay between the procerus muscle and the bone covering. Level of evidence 5.

What it means for a patient

• The dangerous vessels in the nose sit close to the skin, so filler placed deep against the bone or cartilage is further from them.
• The area just above the tip carries a larger artery in nearly two thirds of specimens, making it the higher-risk zone.
• Depth of injection is a technique decision, which is why the injector's anatomical knowledge matters more than the product.
• This is cadaver anatomy from 45 specimens, so it reports where vessels lie rather than how often complications occur.

Why this paper matters

Skin loss and, rarely, blindness from filler injected into a nasal artery are the serious complications of non-surgical rhinoplasty, and guidance on safe depth had been based on general anatomy. Mapping the midline vessels gives that guidance an evidential basis. Whether following it reduces complication rates is untested.

Terms

• Histological analysis: examination of tissue structure under a microscope.
• Subcutaneous: lying just beneath the skin.
• Supratip: the area of the nose just above the tip.
• Rhinion: the point where the nasal bones meet the cartilage on the bridge.