[Medical rhinoplasty: rationale for atraumatic nasal modelling using botulinum toxin and fillers]

To describe the new techniques for medical rhinoplasty, associating fillers and botulinum toxin without invasive surgery, to evaluate their efficiency with a retrospective analysis on 85 patients for 2 years, and to discuss the adequate indications for this new approach.

Between january 2006 and january 2008, 85 patients were treated using a non surgical approach for aesthetic disorders of the nasal pyramid. 62 women and 23 men were included, with different indications: 32 primary rhinoplasties, 53 secondary rhinoplasty corrections. Fillers were used alone in 58 cases, botulinum toxin alone in 12 cases, and both products were used together in 15 cases. Botulinum toxin was always an A-type toxin. For fillers, reticulated hyaluronic acid was used in 56 cases, calcium hydroxyapatite in 11 cases, tricalcium phosphate in 2 cases, L-polylactic acid in 2 cases and polyacrylamid gel in 2 cases. Fillers were injected after application of anaesthetic gel, and placed in depth with osteocartilaginous contact following a retro-tracing movement. At the end of the procedure, the nose was manually modelled in order to improve the product distribution. Botulinum toxin injection was performed without anaesthesia following a specific protocol. Clinical results were evaluated by the patient and the physician immediately after treatment, after 15 days and after 1 month. The satisfaction index was based on 3 answers after 1 month: very satisfactory, satisfactory, insufficient.

In this series of 85 cases, the satisfaction index was very high (66/85 patients, very satisfactory result), higher than the classical values obtained after other treatments of face wrinkles and defects (apart from botulinum toxin effects). The complication rate was very low, with only one reversible case in this series (infection of the tip on a multi-operated nose). The durability of results was dependent on the product: 4 months for botulinum toxin, 12 to 14 months after 2 injections for resorbable fillers.

Medical rhinoplasty provides a large range of therapeutic solutions for minor corrections of nasal morphological or dynamic defects. The benefit/risk ratio for all aesthetic treatments must be high, what implies to reach the best result with the less complex, invasive and brutal protocol. This new approach for rhinoplasty fits in totally with actual patient expectations. The main inconveniences of this approach are the short durability of results and the cost of the procedure repetition.