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D-05
HOW TO PREDICT FILLERS INJECTION RESULTS INTO NASAL ANATOMY

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Introduction: The use of facial fillers has been widely diffused in the various anatomical units, recently we have observed a great demand related to nasal anatomy. It is very important to deal with the unrealistic expectations of patients who actually aim at the results of a surgical rhinoplasty. Dissatisfaction with the results may lead to the application of excessive amounts of product causing compression ischemia and patient often has no idea of what can be obtained from the application of fillers. In this report we present a tactic used by the authors to demonstrate to the patient a simulation of the result using local anesthetic at the application sites of the product. We applied 1% lidocaine without adrenaline in the nasolabial angle, tip or dorsum according to the introduction planning of the filler. Initially we used Lidocaine with adrenaline to effect vasoconstriction and reduce the risk of intravascular injection, but the presence of blanching is one of the signs of ischemia, so we now use only lidocaine without epinephrine. The patient analyzes the simulation of the result and can decide whether to perform the procedure, in addition we get the hydrodissection necessary for the product to be more stable and avoid excessive compression in the tissues leading to ischemia. We observed several advantages in this method: we can use products that do not contain anesthetics because the patient has already received injectable lidocaine, the final result will be better than the simulation because the products used are denser (authors use Juvederm Ultra XC), in addition to the hidrodissection.

Objective: To present a tactic for the simulation of results of the application of fillers in the nasal region and to minimize the risks of ischemia

Methods: After application of anesthetic cream (Lidocaine 23% + tetracaine 7%) for 20 to 30 minutes, we introduced with 30G1 / 2 needle, 1% lidocaine in the quantity and location required to simulate the result. The patient observed and approved the procedure, waited about 15 to 20 minutes for absorption of the liquid mass and proceeded to inject the filler with the patient already anesthetized. When we use more than 0.5 ml we wait about 15 min for new application, avoiding compression.

Results: All the 56 patients who underwent this tactic decided to fill in the nasal region and no complications were observed such as compression ischemia or intravascular injection. In the revision consultations, we performed additional applications in these patients at the same frequency that we performed in those who applied at one time only without the simulation.

Conclusion: We believe this to be an effective tactic to simulate the results and prevent possible complications in the application of fillers in the nasal region.

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