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BACKGROUND: Primary or secondary dorsal augmentation rhinoplasty addresses aesthetic and functional issues related to a deficient, under-projected, or depressed nasal dorsum, frequently in middle vault. Traditional treatments often involve costal cartilage grafts, which can result in palpable irregularities and additional morbidity. Implementing dorsal preservation techniques in selected patients may improve predictability and outcomes of dorsal augmentation. MATERIALS AND METHODS: We conducted a case series involving 12 patients with saddle nose deformities and significant nasal function impairment. All patients underwent either "push-up" preservation technique or "modified dorsal split extended push-up" technique. The techniques were evaluated for feasibility, safety, and efficacy. Functional outcomes were assessed using the nasal obstruction symptom evaluation (NOSE) scale preoperatively and three months postoperatively. RESULTS: Eight patients underwent "push-up" technique, and four patients required "dorsal split extended push-up" technique due to extensive scarring and mucosal adhesions from previous surgeries. All patients demonstrated significant postoperative improvement in nasal function as indicated by a reduction in NOSE scores (p < 0.05). Aesthetic outcomes showed a naturally augmented and smooth dorsum with no palpable irregularities. Patient satisfaction was rated very high (9 or 10 out of 10) in 10 patients and high (7 or 8 out of 10) in 2 patients. Follow-up was 6 months. CONCLUSION: "Push-up" preservation technique and its extended variant provide a new surgical alternative for primary and secondary rhinoplasty with costal cartilage. These techniques offer improved and highly predictable aesthetic outcomes of the nasal dorsum with decreased morbidity, demonstrating significant potential for clinical practice and future research. LEVEL OF EVIDENCE III: 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 .

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To answer the increased demand for augmentation rhinoplasty, particularly in Asian demographics, a shift from autogenous materials to synthetic implants like silicone and expanded polytetrafluoroethylene has been witnessed. These materials present an increased risk of complications like infection, extrusion, capsular contracture, and dissatisfaction. This study focuses on a case of revision rhinoplasty in a 48-year-old patient with a previous silicone implant and propose an innovative approach in managing the implant capsule. The use of the existing capsule as a mechanical and biological support structure for the diced cartilage graft in dorsal reconstruction showcases a promising method to mitigate risks and improve outcomes in revision surgeries. The capsule around the silicone is biologically active and provides a good environment for the cartilage graft to survive and improve the healing process. This approach tends to minimize the dissection to avoid potential revision complications like skin necrosis, fibrotic tissue, and infections.

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Introduction: Augmentation rhinoplasty traditionally represents a serious challenge for plastic surgeons. The association with centrofacial lipofilling is a great approach to achieve harmonious, aesthetic results. The aim of this article is to describe our personal association between Augmentation Rhinoplasty and Centrofacial Lipofilling (ARCL) in non-Caucasian patients. Materials and Methods: In this study, we retrospectively reviewed patients treated with ARCL at our institution between January 2019 and December 2023. We described our personal approach and technique. At a minimum follow-up time of one year, post-operative pictures were taken, and patients were reassessed, evaluating aspects such as global symmetry, shape and contour of the nose, and facial harmony and rejuvenation; finally, patients' satisfaction was investigated according to the ROE questionnaire and the modified S-GAIS. Results: A total of 307 patients were included in the study. They reported a significant satisfactory aesthetic result in nasal image and facial harmony, as the mean postoperative ROE and S-GAIS score show. None of the grafts extruded or collapsed. Wounds healed without reported major infection. Conclusions: This study has demonstrated that ARCL is a safe approach that contributes to improve functional and aesthetic outcomes, has a high patient satisfaction rate, and limited post-operative complications.

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INTRODUCTION: Cartilage is an important source in supporting the structure of the nose for dorsal augmentation rhinoplasty. However, it is known that its viability is not always on the ideal level. Various wrapping materials are used to increase the strength of cartilage. Donor site morbidity, which develops following the harvesting of both cartilage and fascia as one such cover material, has attracted interest in recent years. OBJECTIVE: In this study, we aimed to investigate the potential of dermis and tendon autografts as alternatives to fascia and cartilage. MATERIAL AND METHOD: The sample of the study included 16 New Zealand white rabbits. The right auricular cartilage of all rabbits was amputated, and it was transformed into diced cartilage autografts. The dermis autografts from the right gluteal areas of the rabbits were deepithelialized, and lumbosacral fascia autografts were harvested from the same incision. Additionally, the Achilles tendon of each rabbit was harvested and transformed into diced tendon autografts. Four different autografts were embedded under the skin of each rabbit from 4 different pouches opened in the back of the rabbit. These autografts included diced cartilage alone (Intervention 1), fascia-wrapped cartilage (Intervention 2), dermis-wrapped cartilage (Intervention 3) and fascia-wrapped tendon (Intervention 4) autografts. RESULTS: Intervention 1 had the most irregular appearance, the outcomes in Intervention 4 were volumetrically smaller and softer. Connective tissue formed between the diced pieces in all interventions, and it was observed that the dermis and fascia had a capsule-like appearance, and their viability was preserved. The differences between the initial and final measurements of the volumes of interventions 1, 2 and 3 were statistically significant (p < 0.05). There was no significant difference between the initial and final volumetric measurements of intervention 4 (p > 0.05). More peripheral proliferation was observed in the interventions of fascia-wrapped and dermis-wrapped diced cartilage compared to the other interventions. The intervention including fascia-wrapped diced tendon grafts had displayed more fibrosis, fragmentation and collagen fibers, while it showed a lower amount of elastic fiber. There were no significant differences among the intervention in terms of other histological parameters. CONCLUSION: Tendon autografts may be a good option for dorsal augmentation rhinoplasty as they are easily harvested and have minimal donor site morbidity. Dermis autograft usage is more advantageous than fascia usage in terms of accessibility and convenience. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies and Experimental Studies. 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 .

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Augmentation rhinoplasty or commonly known as "nose jobs" is one of the most common plastic surgical procedures aimed to improve cosmetic appearance. This procedure is considerably safer, less time consuming with faster recovery and immediate cosmetic effect. This procedure needs of highly experienced and well-trained plastic surgeon. According to facial analysis you can select the type of rhinoplasty. Open discussion with the patient to select appropriate surgical technique and its possible risks with your plastic surgeon to ensure the highest level of safety and satisfaction. Autologous grafting materials are safe, efficient and also the first choice for rhinoplasty due to it can survive without a vascular supply, the resorption rate of cartilage is much lower than that of a bone graft. Autologous grafting materials are stable and resistant to infection and extrusion over time so, they are successfully used for dorsal augmentation. To perform successful augmentation rhinoplasty, surgeons should be highly experienced and well-trained and augmentation materials that are currently available and understand their risks, benefits and uses. Autologous cartilage graft regarded as the graft of choice in augmentation rhinoplasty because of their lower rate of infection, rejection, resorption, extrusion, donor site morbidity, easy reshaping.

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BACKGROUND: Enhancing nasal tip projection is an important objective in Asian rhinoplasty. Nasal tip enhancement using auricular cartilage is simple and suitable for Asian patients. However, the long-term retraction problem of the auricular framework still needs to be solved for optimal results. OBJECTIVES: The authors propose a modified auricular cartilage framework construction technique that provides stronger long-term support to the nasal tip and columellar base. METHODS: Eighty-one patients underwent augmentation rhinoplasty between January 2016 and December 2019. The cymba and cavum conchae were harvested from one ear in all cases. The cymba concha was carved and folded to form a caudal septal extension graft (CSEG). The cavum concha was divided into an integrated cap/shield graft and a columella base graft. The columella base graft was diced into particles in size of 1 mm3, and inserted into the gap between CSEG, anterior nasal spine, and the medial crus to strengthen the foundation. The nasal profile was analyzed before the operation and at least 12 months after the operation. The patient satisfaction score was assessed 12 months after surgery. RESULTS: Patients were followed up for 12-36 months. The nasal tip projection from both the lateral and basal views was significantly improved. The columella-labial angle was increased from 83.15° (6.20°) to 96.50° (7.40°) (p < 0.05). The nostril tip proportion increased from 0.83 (0.14) to 1.17(0.16) (p < 0.01). A stable long-term outcome was achieved. CONCLUSIONS: With the modified framework construction technique, long-term nasal tip drooping can be prevented. This method can be a practical choice for Asian patients seeking augmentation rhinoplasty.

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OBJECTIVES: We investigated the satisfaction and nasal airway function of patients who underwent L-shaped augmentation rhinoplasty using rhinoplasty outcomes evaluation (ROE). Nasal obstruction was evaluated using the nasal obstruction symptom evaluation (NOSE) and peak nasal inspiratory flowmeter (PNIF) score. We explored the correlation between tip projection, ROE, NOSE, and PNIF scores. METHODS: We conducted a pre-and post-experimental study of 16 adult Indonesian patients who underwent L-shaped augmentation rhinoplasty. We used the neurotic scale to rule out patients with body dysmorphic disorder (BDD), and patients with low-to-moderate neurotic scores were included as participants. RESULTS: For all patients who underwent augmentation rhinoplasty, the median score of the NOSE questionnaire decreased from 12.5 to 5 after surgery (P = .005). The ROE median satisfaction scores also increased from 7.00 to 14.00 postoperatively (P = .001). The median PNIF preoperative score increased from 92 (70-130) to 115 (105-155) postoperatively. There was an increase in tip projection from 1.5 (1.1-2) preoperative to 2.05 (1.8-2.5) postoperative. There was a significant correlation between ∆ tip projection and ∆ NOSE (P = .048), with a moderate correlation (r = .502). However, there was no significant correlation between ∆ tip projection and ∆ PNIF (P = .080) and ∆ ROE (P = .302). CONCLUSION: The increase in ROE and PNIF, and the decrease in NOSE score after surgery revealed that the augmented L-shaped rhinoplasty technique has high satisfaction rates in both the nasal esthetics and functions of patients. The tip projection increment was proven to elevate nasal function subjectively in a certain range of tip height difference evaluated by the NOSE score.

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OBJECTIVE: This study was designed to analyze the clinical effect of autologous fat-granule transplantation in augmentation rhinoplasty and explore methods to improve the fat retention rate. METHODS: A total of 70 enrolled patients were randomly divided into 2 groups: the platelet-rich fibrin (PRF) combined with high-density fat transplantation group (combined group) and the conventional fat-granule transplantation group (control group; n = 35 in each group). In the combined group, an appropriate amount of autologous fat was extracted and centrifuged, and the lower layer of high-density fat was taken and mixed with PRF isolated from whole blood for autotransplantation. In the control group, only fat was extracted and centrifuged for transplantation. The patients were followed up with for more than one year to observe the short- and long-term effects, complications, safety, and patient satisfaction. RESULTS: Six months after the operation, the nasal shape was stable, the contour was higher and more stereoscopic than before, the average increase of nasal height was 3.0 mm in the combined group and 2.0 mm in the control group. No complications, such as fat embolism, infection, or necrosis occurred during the 1-year follow-up. The satisfaction rate between the 2 groups has statistical significance (P < .05). CONCLUSION: Overall, PRF combined with autologous high-density fat transplantation is simple to perform, has a significantly increased fat-retention rate than the control group, and has stable long-term effects without obvious adverse reactions. A sufficient amount of fat and PRF transplantation can achieve a good orthopedic effect. Thus, this method can be widely used in clinical augmentation rhinoplasty.

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The subdorsal cantilever graft (SDCG) is a costal cartilage graft that is positioned below the nasal dorsum to control the position of the nasal bones and middle nasal vault. SDCG type A is used to raise the middle nasal vault and caudal nasal bones to correct the saddle nose deformity. SDCG type B can be used to raise the entire dorsum of the nose (radix, bony vault, and middle vault) in the ethnic augmentation rhinoplasty patient. This article will discuss the indications and technique of the SDCG in dorsal preservation rhinoplasty.

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OBJECTIVE: to better reconstruct the nasal shape after cleft lip repair with 3D printing assisted autologous costal cartilage augmentation rhinoplasty, especially for patients with radix augmentation needs. METHOD: 20 patients with nasal deformity secondary to cleft lip repair and radix augmentation needs had received surgical treatment from July 2016 to November 2021. A total of 10 cases were treated with autologous costal cartilage augmentation rhinoplasty for nasal deformity after cleft lip repair, and 10 cases were treated with the help of 3D printing. According to the characteristics of nasal deformity, autologous costal cartilage was carved and implanted into the nose back. RESULTS: 3D printing assisted autologous costal cartilage augmentation in the treatment of nasal deformity after cleft lip repair, the incision healed well, and there were no complications in the thoracic cartilage donor area. The shape of the nose is satisfactory, the height and shape of the nose tip and the size of both nostrils are mostly symmetrical, the nasal columella is elongated, the original nose tip is flat, the collapse of the nose wing is satisfactory, and the nose lip angle is close to normal. CONCLUSIONS: 3D printing assisted autologous costal cartilage augmentation is an ideal treatment for nasal deformity after cleft lip repair.

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OBJECTIVE: To observe the effect of methylene blue combined with ropivacaine intercostal nerve block on postoperative analgesia after autologous costal cartilage augmentation rhinoplasty. METHODS: In this study 100 female patients who underwent autologous costal cartilage comprehensive augmentation rhinoplasty in Chongqing Huamei Plastic Surgery Hospital from April to November 2021 were randomly divided into an experimental group and a control group, with 50 cases in each group. In the experimental group methylene blue was combined with ropivacaine intercostal nerve block as patient controlled intravenous analgesia (PCIA), and the control group was ropivacaine intercostal nerve block combined with PCIA. The visual analogue scale (VAS) scores of resting and coughing at 6 h (T1), 24 h (T2), 48 h (T3), 72 h (T4) after surgery were recorded and evaluated. At the same time, the number and times of oral analgesics were recorded as well as nausea, vomiting, burning pain and paresthesia. RESULTS: The VAS scores of the experimental group were lower than those of the control group at all time points. At 6 h, 24 h and 48 h after surgery, the VAS score of the experimental group was lower than that in the control group, but the difference was not statistically significant (P > 0.05). The VAS score of calm 72 h after surgery in the experimental group was significantly lower than that in the control group (P < 0.05). The analgesic effect of the two groups was better when they coughed after surgery. At 6 h after surgery, the VAS score of coughing in the experimental group was lower than that in the control group, but the difference was not statistically significant (P > 0.05); At 24 h, 48 h and 72 h after surgery, the VAS score of the coughing state in the experimental group was significantly lower than that in the control group (P < 0.05). CONCLUSION: Intercostal nerve block with methylene blue combined with ropivacaine can achieve good postoperative analgesic effects in augmentation rhinoplasty with autologous costal cartilage.

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BACKGROUND: Various techniques with different grafts and implants have been proposed to establish a smooth and symmetric nasal dorsum with adequate function. Broadly, two categories of materials have been used in this regard: alloplastic implant materials and autograft materials. The aim of these meta-analyses is to explore the incidence of complications after dorsum augmentation surgery using alloplastic materials. MATERIALS AND METHODS: After duplication removal 491 papers remained that title and abstract were assessed for eligibility. Regarding the study type, 27 observational studies were included, 21 retrospective and 6 prospective case series. A total of 3803 cases were enrolled in this systematic review and meta-analysis. RESULT: Twenty-seven articles reported on complications and outcomes of dorsal augmentation rhinoplasty with synthetic materials. In a random-effects model, the weighted mean percentage was 2.75% (95% CI 1.61 to 4.17%). the weighted mean percentage were 1.91% (95% CI 0.77 to 3.54%), 0.72% (95% CI 0.316 to 1.31%), and 0.78% (95% CI 0.43 to 1.24%) respectively. CONCLUSION: The widely used alloplasts were expanded polytetrafluoroethylene (ePTFE), high-density polyethylene, and silicone. The total rates for complications, infection, deviation, irregularity, hematoma, extrusion, and overcorrection were 2.75%, 1.91%, 0.72%, 0.70%, 0.78%, and 0.49%, respectively. The revision rate, based on the random effects model, was 6.40% with 95%CI (3.84 to 9.57). TRIAL REGISTRATION: This meta-analysis was registered at the International Prospective Register of Systematic Reviews (PROSPERO, registration number CRD42020209644 ).

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BACKGROUND: The free diced costal cartilage (FDCC) injection technique has been used in the augmentation rhinoplasty for a long time. In order to lower the incidence of nasal contour irregularities and graft displacement, we developed the multiple toothpick-shaped costal cartilage (MTCC) injection technique. This comparative study was conducted to introduce and assess this new technique. METHODS: This retrospective analysis included 51 patients who underwent augmentation rhinoplasty with either the FDCC or MTCC injection technique at the 17th Department of Plastic Surgery in the Plastic Surgery Hospital between July 2014 and May 2020. The patients were divided into the FDCC (n = 30, 58.82%) and MTCC (n = 21, 41.18%) groups. General data, postoperative patient satisfaction, complications and revision rate were compared between the groups. RESULTS: Except for the follow-up period, there were no significant differences in general data (age, sex, preoperative dorsum deformity, preoperative rhinoplasty history) between the groups. Postoperative patient satisfaction, complications and revision rate were similar between the two groups. CONCLUSIONS: The MTCC injection is a safe and effective technique for augmentation rhinoplasty. Like the FDCC injection technique, the new technique is relatively easy to perform and time-saving with concealed scarring and minimal postoperative edema. Most of its revision surgeries are also easy to perform by simple rasping and reinjection. According to our experience, the new technique may have wider indication as well as lower incidence of nasal contour irregularities and graft displacement. Therefore, we suggest that the MTCC injection technique is reliable and worthy of recommendation. 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 .

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BACKGROUND: Correction of saddle nose deformity is one of the most frequently sought surgeries by patients seeking rhinoplasty in Asian countries. Nasal dorsal augmentation always requires graft material to achieve the desired result. Various autologous grafts and alloplastic materials have been described in the literature with their advantages and disadvantages. We report our study on the use of olecranon bone graft for augmentation rhinoplasty in severe saddle nose deformity and discuss our experience with it. MATERIALS AND METHODS: In this observational study, 12 patients who underwent dorsal nasal augmentation using olecranon bone graft from August 2011 to December 2020 were studied. All ten patients with congenital deformity underwent graft insertion through a closed rhinoplasty approach, whereas two patients with posttraumatic deformity were operated through old scars over the nasal dorsum. The graft was fixed with screws at nasion in both posttraumatic cases. All the patients were evaluated postoperatively at regular intervals for graft resorption by clinical photographs and X-ray nasal bone. RESULTS: The age ranged from 20 years to 48 years. No immediate complications related to graft placement were noted. One patient had a hairline fracture of the ulna at the donor site on the 3rd postoperative day which was managed conservatively with a cast. The mean follow-up period was 2 years. No nasal dorsum projection loss or signs of bone resorption were observed for up to 5 years after surgery. One patient with posttraumatic deformity required removal of fixation screw which got exposed after 2 years of surgery. CONCLUSION: Olecranon bone graft is a suitable material for nasal dorsal augmentation in severe saddle nose deformity because of ease of harvest and minimal donor area morbidity. The appropriate thickness of the cortex of the olecranon process allows custom molding and provides resistance to resorption in long term, thereby giving a desirable outcome.

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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 .

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Progressive premaxillary retrusion is a common sequela of the facial aging process. In most cases, this manifests with central maxillary recession. Central maxillary insufficiency is also commonly encountered within certain ethnic communities, or in cleft lip nasal deformity, and may represent a challenge for the plastic and reconstructive surgeon attempting correction in the setting of facial contouring, rhinoplasty, or reconstruction following oncologic resection or trauma. Aesthetically, premaxillary retrusion may be coincident with an acute nasolabial angle and ptotic nasal tip. Minor deformities may be addressed with use of either alloplastic implants, autogenous tissue, lipotransfer, or injectable filler. Larger composite defects may require reconstruction with implementation of free tissue transfer. Herein, we describe techniques that aim to augment, or reconstruct, the premaxillary region in the context of nasal deformity, osseous resorption, or composite maxillofacial defects.

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The goal of rhinoplasty is to improve the nose aesthetically as well as functionally. Surgical access to the nose can be gained via close rhinoplasty, open rhinoplasty) or a combination of the two. To assess various types of nasal deformities, aesthetic results of open rhinoplasty and pitfalls of open rhinoplasty in patients planned for surgery. This prospective longitudinal study was done in the Department of ENT GMC Jammu between November 2015 and October 2016. This included patients with nasal deformities willing for corrective surgery, above 18 years of age. Postoperative aesthetic parameters were measured to evaluate the aesthetic outcomes on the 2 weeks, 6 weeks and 3 months. Post-operative complications were noted. 20 patients were admitted for open septorhinoplasty; crooked nose was the most common deformity found in 55% of the patients. Nasal trauma (50%) was most common cause of external nasal deformity. Autologous septal cartilage was used in 85% patients while autologous auricular cartilage was used in 15% patients. Eyelid edema was the most common complication seen. In this study according to the patient follow up self-evaluations, 65% patients were partially satisfied and 35% patients are satisfied with the aesthetic results. Additional procedures are required along with rhinoplasty for better results of surgery. Open rhinoplasty is better cosmetic surgery for the correction of nasal framework defects and post-operative complications are quite low with the open rhinoplasty.

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BACKGROUND: There are no studies about the treatment of nasal bone fractures in patients with dorsal augmentations using silicone implants. We aimed to describe the characteristics of nasal bone fracture in patients who underwent rhinoplasty and compare the difference between closed reduction and conservative treatment of nasal bone fractures in patients with a history of rhinoplasty. METHODS: Between January 2013 and June 2018, a total of 463 patients were admitted to our center for nasal bone fracture; 17 patients with nasal bone fractures who underwent rhinoplasty were included, of which, five underwent closed reduction in the nasal bone and 12 underwent conservative treatment. Three of 12 patients who were initially treated conservatively underwent a secondary rhinoplasty for esthetic improvements. All patients were classified according to fracture site and the presence of a nasal septal fracture-in accordance with the modified Murray classification-and were analyzed for the correlation between fracture type and disease course. RESULTS: The nasal bone fracture types per computed tomography findings were unilateral (n = 13), bilateral (n = 4), septal (n = 1), and M-type (n = 1). No significant differences in fracture site (P > 0.05) and the presence of a nasal septal fracture (P > 0.05) were found between the groups. Fracture type did not significantly differ among patients who underwent closed reduction, conservative treatment without secondary rhinoplasty, and secondary rhinoplasty (P > 0.05). CONCLUSIONS: Despite risking traumatic capsular rupture, implant removal is seldom required and closed reduction is recommended if visible deviations are present; otherwise, only conservative treatment is recommended. 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.

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BACKGROUND: Soft tissue filler injection is a common procedure for augmentation rhinoplasty. Various techniques for augmenting the nasal dorsum using a soft tissue filler have been attempted considering the size of the needle, the anatomical layer where the filler is injected, and the vascular distribution. The purpose of this paper was to evaluate the course of the dorsal nasal artery in patients scheduled for nasal augmentation using a soft tissue filler and to propose a method of nasal augmentation that minimizes vessel damage during soft tissue filler injection by confirming the distribution pattern of blood vessels through ultrasound. METHODS: Patients underwent augmentation rhinoplasty using a soft tissue filler. All patients underwent ultrasound examination before the filler injections. RESULTS: From July to September 2018, ultrasound studies were conducted before augmentation rhinoplasty in 50 consecutive patients. Forty patients (80%) had a well-known lateral arterial pathway, while in 10 patients (20%), the dorsal nasal artery was found at the midline of the nose. In four cases (8%), the artery travelled just beneath the preperiosteal layer, which is under the nasalis muscle. Additionally, in seven cases (14%), the dorsal nasal artery coursed superficially, just beneath the subdermal layer. CONCLUSION: Injecting the filler into the preperiosteal layer either via a needle or cannula is considered relatively safe but there remains the possibility of vascular compromise. Using a large diameter cannula and injecting the filler into the preperiosteal layer using a gentle approach may be the safest approach.

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The face is the most expressive zone of the human body that communicates our feelings and thoughts. This may also influence the interaction between people. The aesthetic adjunctive procedures are life-changing. In contemporary orthodontic treatment, orthognathic surgeries are performed to correct the functional aspects of dento facial deformities. In cases where the aesthetic outcome is not improved, patient dissatisfaction is often encountered. Many adjunctive surgical procedures can be used to enhance the anaesthetics of orthodontic or orthognathic surgical cases. Dwelling not merely on the ideal occlusion, the results could be enhanced by analysing the whole-face to improve the overall treatment outcome.

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