Cannula versus needle in medical rhinoplasty: the nose knows

Abstract

The use of hyaluronic acid (HA) fillers has become a popular alternative for nose remodeling, although poor understanding of the nasal anatomy has resulted in adverse events and generated some controversy. Among them, is the question of where and when to use cannulas vs needles. Through multiple cadaver dissections, clinical experience and the review of medical literature the authors conclude the use of needle over cannula is preferred, assuring a correct injection plane lying fully against the bone or cartilage. Although blunt in nature, cannulas may lead to difficulty in determining with precision the exact depth of product placement and contribute to more dissection of adjacent structures. Thorough knowledge of the highly variable nasal anatomy, including vessel depth location is of outmost importance in avoiding adverse events. Good patient selection is critical where most noses for augmentation rhinoplasty and some reduction rhinoplasty candidates where the goal is to camouflage the dorsal hump are amenable to medical rhinoplasty, unless there is reduced skin elasticity of nasal soft tissues or distortion of anatomy from surgery or trauma. Appropriate product selection is important for effective results. The authors suggest fillers with low cohesivity and high lifting capacity. Finally, we suggest a technique referred as Rhinosculpting base in the use the use of three conceptual elements: facial analysis, light reflection, and use of HA gel as a cartilage graft, in combination with the detailed injection technique presented in this article, which ensures a safer and satisfying treatment outcome.

Displacement of Hyaluronic Acid Dermal Filler Mimicking a Cutaneous Tumor: A Case Report

“…For the same reason, in order to avoid adverse events, administration of the product should be conducted under low pressure and low volume, preferably in the supraperiosteal or supraperichondrial planes. 7,13,15,16 Regarding this last recommendation, however, some authors advocate injecting subcutaneously or in multiple layers. [17][18][19][20] Anyway, even small 0.1 cc aliquots of filler can result in inconsistent placement in the supraperiosteal layer and dispersal of product into other anatomic layers, despite the needle tip remaining in contact with the periosteum.…”

The current techniques in dorsal augmentation rhinoplasty: a comprehensive review

“…A hyaluronidase enzyme breaks down HA, making nose injections easy to revert and without the risk of an allergic reaction. It is recommended that silicone should not be used in nasal injections because granulomas, infection, and other adverse effects are associated with it [ 91 ]. It has been practiced off-label for many years to perform “liquid,” “nonsurgical,” or “injection” rhinoplasties.…”

Are large diameter cannulas safe in nonsurgical rhinoplasty?

“…A growing number of studies focusing on the nasal region demonstrate that injection into the supraperiosteal or supraperichondrial layers can significantly reduce the risk of complications 2,13 . Blunt by nature, cannulas can make it difficult to accurately determine the exact depth of product placement 14 . Still, using a sharp needle can potentially result in arterial embolization, even when the needle is in constant contact with the periosteum 15 .…”

“…2,13 Blunt by nature, cannulas can make it difficult to accurately determine the exact depth of product placement. 14 Still, using a sharp needle can potentially result in arterial embolization, even when the needle is in constant contact with the periosteum. 15 Regardless of the chosen device (cannula or needle), emphasis must be placed on proper injection techniques.…”