Nasal dorsum augmentation using soft tissue filler injection
Won Lee MD, PhD  Ji‐Soo Kim MD, MS  Wook Oh MD  Ik‐Soo Koh MD, PhD  Eun‐Jung Yang MD, PhD
First published: 03 June 2019 https://doi.org/10.1111/jocd.13018
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Abstract
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.