Hyaluronic Acid Filler in the Treatment for Drooping Tip: Anatomical Concepts and Clinical Results
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ORIGINAL ARTICLE
RHINOPLASTY
Hyaluronic Acid Filler in the Treatment for Drooping Tip: Anatomical Concepts and Clinical Results Helena Hotz Arroyo Ramos1 • Ingrid Paula Lu¨ckmann Bernardino2 Ritha de Ca´ssia Capelato Rocha3
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Received: 8 May 2020 / Accepted: 9 June 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Abstract The plunging nasal tip is a challenging condition because, although it is predominantly a dynamic deformity which occurs during smiling, it also indicates a structural problem. When a person smiles, the paired depressor septi nasi muscles pull the tip caudally at the same time as the levator labii superioris alaeque nasi muscles pull the alar base and lateral lip cephalically. This movement causes straightening of the alar rim. Even though surgical rhinoplasty is the gold standard to restore nasal appearance, the procedure may fail to treat the dynamic cause of the drooping tip. This article outlines the anatomical concepts that lead to a drooping tip and presents a technique that can treat both the dynamic and structural causes of the drooping tip using hyaluronic acid filler. Cases are also presented that illustrate these concepts. Level of evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Keywords Fillers Nose filler Augmentation rhinoplasty Hyaluronic acid Injectables Aesthetic facial procedures
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00266-020-01836-6) contains supplementary material, which is available to authorized users. & Helena Hotz Arroyo Ramos [email protected] 1
Vitoria, Brazil
2
Florianopolis, Brazil
3
Maringa, Brazil
Introduction Rhinoplasty is the third most common cosmetic plastic surgery procedure. However, in 2018, the number of procedures showed a slight decrease when compared to 2017 [1]. On the other hand, the number of patients requesting procedures using soft tissue fillers continued to increase [1], including nonsurgical rhinoplasty with hyaluronic acid (HA) filler [2]. This may be due to the less invasive nature of these procedures and minimal downtime compared to surgical cosmetic procedures. Even though surgical rhinoplasty is the gold standard for reshaping the nose, nonsurgical rhinoplasty can lead to good outcomes and includes procedures to rectify a drooping nasal tip [3]. The plunging nasal tip is a challenging condition because, although it is predominantly a dynamic deformity which occurs during smiling, it also indicates a structural problem [4, 5]. There is no consensus on whether the tip actually droops during smiling due to the combined action of upper lip elevators and the downward pull of the orbicularis oris, myrtiformis, and depressor septi nasalis (DSN) muscles or whether this is an ill
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