Treatment of Nasal Ageing and Possible Long-term Nasal Enhancement with Fat Using Injectable Tissue
Minimally invasive rhinoplasty procedures have had increased public acceptance/desire for augmentation of the nose. Recent studies have demonstrated the use of fat grafting for nasal augmentation with good rates of satisfaction in the majority of patients. Different anatomical zones such as the nasal sidewall and dorsum may be sculpted via injections. Postrhinoplasty asymmetries, contour irregularities, and saddle nose deformities may also be treated using fat grafts in patients reluctant to undergo further surgical revision.
Facial & Nasal Ageing
As we age, the entire soft tissue envelope around the nasal area slides down the nasal bones while the tip plunges, and the upper lip lengthens. Some may also experience volume loss, causing pyriform atrophy; which is often associated with the deepening of nasolabial folds that gives the upper lip, nose, and nasolabial folds a “sucked” in appearance.
Nasal ageing is also associated with changes in the glabellar region, forehead, and brow, which are subject to the loss of prominence with the thinning of soft tissues and deepening of frown lines. Supraorbital brow and glabellar projection also influence the nasofrontal junction in patients who are experiencing facial ageing as well as in patients with a high radix or shallow nasofrontal junction.
Fat Fillers vs HA Fillers
Until recently, soft tissue fillers, such as, and especially, hyaluronic acid (HA) is the most commonly and usually the most preferred type of filler to be used to treat nasal ageing and enhancement. This is likely due the short down-time and possibility of reversing excess by dissolving it with other substances. However, based on the 2018 statistics released by ASPS, more and more patients are favouring the use of fat fillers for face.
This growing popularity can be largely attributed to the safety aspects brought about by fats fillers when compared to other fillers, as fat is known to be one of the safest, if not the safest, and most natural filler material available; since it uses the patient’s own fats to replace the lost volume/fat - hence, eliminating any risks of an allergic reaction.
In addition, fat fillers not only restore lost volume in a desired area, but many studies have evidenced that the stem cells found in fat injections can also help provide patients with a more youthful and rejuvenated look as the fats that survive the injection process becomes living tissues, thus allowing the effects to be more natural and longer-lasting.
Treating and Enhancing Nasal Area with Fat using Injectable Tissue Replacement
In his publication titled "Treatment of Nasal Ageing and Possible Long-term Nasal Enhancement with Fat Using Injectable Tissue Replacement”, IFAAS faculty, Dr. Steven R. Cohen discussed how more than 90 cases of nasal area treatment and enhancement were successfully performed during face lift surgery over the past 2 years (2017-2019) were without complications, while showing significant improvements in virtually all patients - with 3 patients requesting further fat grafting treatments.
Fig. 1: The patient is shown before (A, B) and 1.5 years after receiving full facial fat grafting using Injectable tissue Replacement. Patient was treated with a high Superficial Musculoaponeurotic System (SMAS) facelift, ITR for nasal disfigurement and ageing and a fractional dual laser to perioral region and chin (C, D).
Areas Addressed in Techniques
1. Pyriform/nasal base and tip projection
2. Columella injection for minimally invasive strutting and tip elevation with natural supra-tip break
3. Dorsal nasal augmentation, symmetry, and/or smoothing
4. Glabellar and superior orbital rim augmentation in patients with atrophy secondary to age, genetics and/or in patient with high radix
By injecting the right type of fats (Millifats, Microfats and Nanofats) into the pyriform, columella, radix, brows, glabella and superficial areas of the nasal area, Dr. Cohen and his team was able to successfully deliver a more elevated tip projection and columellar strutting in patients.
The primary advantage of this minimally invasive procedures is it can be preformed during a separate surgery or in a clinical setting with topical and local anesthesia. An overall improvement in nasal aesthetics was obtained, including the glabella and lower forehead along with the degree of pyriform and dental projection. The use of fat as a natural filler for the nose has also resulted in a longer-lasting effects of up to 1.5 years post-procedure and the minimally invasive rhinoplasty procedure using Injectable Tissue Replacement (ITR2) fat grafting has proved to be a new, reproducible approach, that demonstrated moderate-to-high rates of satisfaction in patients.
Hope you have enjoyed the article! Stay tuned for our future posts on more techniques and information related to our advanced aesthetic and cosmetic training courses!
Resources:
https://www.plasticsurgery.org/documents/News/Statistics/2018/plastic-surgery-statistics-report-2018.pdf
https://www.isaps.org/procedures/body/fat-transfer-body/
https://journals.lww.com/prsgo by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3StWKv21Bgey3yfgF5ETJ86Kx96+OsvIENne/uhyeAQQ7nNS7oyF6lQ== on 06/10/2019
Learn How to Deliver a More Natural and Longer-Lasting Result in Your Patients using Dr. Steve R. Cohen's Exclusive ITR2 Technique at our upcoming Mini-Fellowship happening in San Diego, California, USA
IFAAS Mini-Fellowship (Observation)
Tissue Replacement and Regeneration & ABC Face Lift
August 15-16, 2019: San Diego, California, USA
SEATS FILLING FAST!
More upcoming Non-Surgical Face Lifting & Rejuvenation Aesthetic Trainings happening globally: