Primary or secondary correction of nasal bridge deformities is now well known to be corrected by injectable fillers. The use of hyaluronic acid-based (HA) injectable fillers provides a quick and very directed approach to a wide variety of nasal contour deformities. While effective, no HA filler to the nose provides a permanent contour correction in the vast majority of patients.
I have run across a handful of patients that stated they had gotten one HA injection to the nose years ago and the result was sustained. But it is hard to know whether this is merely cosmetic accommodation or was indeed a ‘permanent’ result. I suspect that of the nasal contour issue was significant, such a permanent result would not have been seen. I know from injecting a lot of dorsal hump patients with HA fillers to camouflage it (placing filler above the hump to create a straight dorsal line) that such filler volumes are not sustained in the nose.
An alternative and permanent options for larger primary or secondary dorsal line defects is that of a diced cartilage graft injection. This is a concept that, while injected, must be differentiated from that of HA filler injections. This is where cartilage grafts from either the septum, ear or rib are processed to make them injectable. This is done by cutting (dicing) them into small 1 x 1mm cubes (or smaller) and placing them into an open barrel 1ml syringe.
Through an intranasal (intercartilaginous) incision, a tunnel is made on the dorsum up onto the upper dorsal defect area. (frontonasal junction, radix, nasal sidewall) The syringe is introduced and the compressed cartilage grafts are injected in the desired amount and shaped externally. The grafted area is taped to hold the desired shape for 7 to 10 days.
While many diced cartilage are traditionally wrapped in surgical or fascia, there is a role in smaller nasal dorsal defects for direct injection of the cartilage. The small nasal tunnel and confinement of the syringe allow the cartilage particles to be precisely delivered.
Dr. Barry Eppley