Hybrid Nasal Filler: Combining Agarose Gel and Hyaluronic Acid for Nonsurgical Rhinoplasty

Overview

The authors argue no single filler suits every part of the nose, so they developed a hybrid model using two materials with different properties. Hyaluronic acid, which attracts water, was used in one set of locations, and agarose gel, which does not attract water and is firmer, in another. Patients presenting for non surgical nasal correction over a two year period were enrolled.

Sections of note

• Case series of 32 patients, mean age 27 years.
• Hyaluronic acid was injected into the skin at 0.1 mL per point at the tip defining points and the supratip.
• Agarose gel was injected onto the bone at 0.4 to 0.7 mL at the radix and 0.4 to 0.6 mL at the nasal spine.
• Improvement was assessed two weeks later using the Global Aesthetic Improvement Scale from 1 to 5, where 1 is exceptional improvement.
• Patient satisfaction was rated from 0 to 10.
• Mean satisfaction was 9.09 after injection and 9 at two weeks.
• Clinical evaluation scores were 1.72 out of 5 after injection and 1.69 at two weeks.
• No major complication was observed.

What it means for a patient

• Different regions of the nose were treated with different materials chosen for their firmness and water attraction.
• Satisfaction and clinician assessment held steady across the two weeks measured.
• Follow up was only two weeks, so nothing is known about duration or later complications.
• Thirty two patients cannot detect the rare vascular complications associated with nasal filler.

Why this paper matters

Filler rhinoplasty usually uses one product throughout, and the properties needed at the bridge differ from those needed at the tip. This series tests matching material to location. Two week follow up in 32 patients establishes feasibility, not safety or durability.

Terms

• Hyaluronic acid: an injectable gel that attracts water and can be dissolved.
• Agarose gel: a firmer injectable material that does not attract water.
• G prime: a measure of a filler's firmness and resistance to deformation.
• Supraperiosteal: placed directly on the bone, beneath its covering membrane.
• Nasal spine: the small bony projection at the base of the nose.
• Global Aesthetic Improvement Scale: a rating of how much appearance changed after a procedure.