A Safer Non-surgical Filler Augmentation Rhinoplasty Based on the Anatomy of the Nose

Overview

Filler injection into the nose can block blood vessels, causing skin death or blindness. The authors compared two injection routes in cadavers, measured the angle and depth involved, then used ultrasound in living patients to check where filler actually ended up when injected from the tip.

Sections of note

• Colored filler was injected into cadavers for bridge augmentation using two methods.
• Retrograde injection placed filler into the superficial layer in three cadavers.
• Direct percutaneous injection placed filler into the deep layer in another three cadavers.
• The concavity of the sellion area was measured on lateral cephalography X-ray images.
• The average angle between the bridge skin and the sellion was 10.2 plus or minus 2.8 degrees, with a minimum of 5.1 degrees.
• The average distance between needle tip and nasal bone was 1.9 plus or minus 0.3 mm, minimum 0.4 mm.
• Ultrasound was used to locate filler in 20 Korean patients injected into the sellion from the infratip lobule. Level of evidence IV.

What it means for a patient

• Where the needle enters determines how reliably the filler lands on the bone, where it is safest.
• Injecting the root of the nose from the tip means threading along a shallow angle, leaving little margin above the bone.
• The authors recommend entering from between the eyebrows instead when treating the root.
• Limits: 6 cadavers and 20 patients, no complication outcomes measured, and the safety benefit is inferred from anatomy rather than demonstrated in patients.

Why this paper matters

Blindness and skin necrosis from nasal filler are rare but catastrophic, and guidance on technique has been largely anecdotal. This gives measured anatomical reasons for choosing an injection route. It does not report complication rates for either method.

Terms

• Sellion: The deepest point of the bridge between the eyes, the root of the nose.
• Glabella: The smooth area between the eyebrows.
• Retrograde injection: Injecting while withdrawing the needle backward along a path.
• Percutaneous: Through the skin, directly.
• Supraperiosteal: Just above the membrane covering the bone.