Clinical Aesthetics of the Nose for Filler Injection

The most recent trend and biggest issue regarding aesthetic surgery is natural beauty; therefore, minimally invasive plastic surgery techniques have been developed. This is advantageous because it allows patients to easily return to their everyday lives, does not require the use of a knife, causes less swelling, and leaves no signs of surgery. Knowledge pertaining to the type of approach is necessary in view of the reference, including the absoluteness and relativity of beauty in terms of the face and nose features that are desirable to the patient. Therefore, the present author discussed the use of fillers based on the four criteria of beauty for Asians. First, in cases where the forehead is convex from a lateral view and sellion, a concave nose is considered beautiful. The nasofrontal angle is formed between the inferior forehead and the nasal dorsum. This angle ranges between 125 and 135°. Second, when a horizontal line parallel to the Frankfort line from the sellion is drawn, it should meet the eyelashes or upper margin of the pupil in Asians. Third, the dorsal aesthetic lines should be gently diverging and curve between the medial brow and the tip-defining points. Fourth, a straight nose is considered more beautiful for men and a nasal tip that is 1 to 2 mm higher than the nasal dorsum is considered more beautiful for women. The nasal dorsum lies slightly behind a line drawn from the radix to the nasal tip, more so in women than in men. Therefore, to create an aesthetically attractive nose, volume augmentation using a filler from the sellion is insufficient. The nasofrontal angle becomes wider, and the sellion moves to a higher position. Therefore, the filler should originate at the glabella and continue to the columella until the end of the nose while maintaining the nasofrontal angle. The position of the sellion should be an extension of the double eyelid. A dorsal aesthetic line can be created from the supraciliary ridge to the tip-defining points by inserting fillers from the glabella area, lessening the width and straightening the concavity. In addition, the columella should be filled with fillers to raise the nasal tip to create an aesthetically perfect nose shape ([Figs. 1] and [2]).

Fig. 1 (A) An ideal nose shape. (B) A method of volume augmentation with fillers from the sellion. (C) A method to insert fillers starting from the glabella area. (D) A method to raise the nasal tip.

Fig. 2 A 23-year-old woman was injected with the filler (Amalian 24 SF advanced; S&V Technologies). (A) Preoperative photograph of oblique view. (B) Immediately postoperative photograph of oblique view.

To minimize the risk of adverse events, such as necrosis or blindness, the injection must be placed into the deep fatty layer where there is almost no vasculature. Moreover, a blunt cannula should be used and the procedure should be performed carefully and methodically while compressing both sides of the nose to make sure the filler does not flow into the blood vessels. Of course, one limitation is that the shape of the nose can only be changed ∼2 to 3 mm by using fillers. Moreover, the nose requires precise analysis in the context of overall facial proportions. However, an absolute standard of beauty has been established as a criterion for evaluating the attractiveness of the face. Surgeons must be aware of the aesthetic standard and perform procedures based on this standard to obtain optimal results.