Fig. 55.17 Surgical hump

state. Patients who, along with aesthetic disorder, have a functional one, do not have postsurgical psychological changes as a rule. The change of their looks is linked to the increase of their self-content. The patients who undergo an aesthetic surgery exclusively could be the patients who have underlying mental disorders. Certain authors find more mental disorders in women, while some other in young men [27, 28]. A mental disorder that can have the worst consequences such as suicide or murder of the surgeon is found in patients with dismorphophobia [29].

55.6 Conclusions

While performing a rhinoplastic surgery, it is necessary for the surgeon to think of the function first and aesthetic aspect second.

Presurgical planning is of the highest significance in preventing postsurgical complications.

A psychological profile estimation is extremely important. If a personality disorder is suspected, it is necessary to consult a psychiatrist.

As for the profile aspect of the face, nose dorsum is the most important being a dimension which cannot be seen by an individual and at the same time the most common reason for undergoing a rhinosurgery.

A kyphotic nose is the most frequent deformity of nasal pyramid, often without nasal septum deviation. It is relatively easy to be operated.

Being knowledgeable about possible complications and solving them is the main condition for a surgeon to be into aesthetic and functional nose surgery.

References

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56.1 Introduction

Due to its low morbidity and the high patient satisfaction, nonsurgical rhinoplasty (also known as a nonsurgical nosejob) is a viable option for primary nasal augmentation and for correction of nasal deformities. Nonsurgical rhinoplasty, whether performed for primary nasal augmentation or postoperative revision, is increasing in popularity due to advancements in the various soft-tissue fillers. There is no FDA-approved soft-tissue filler specifically directed for nonsurgical rhinoplasty as yet; however, various soft-tissue fillers have been used in off-label protocols with mixed results. Examples of such fillers include injectable silicon (a device banned by the federal government [1]), collagen, nonand crosslinked hyaluronic acid, and calcium hydroxyapatite (CaHA). These alloplasts are regarded as minimally invasive counterparts to cartilage, fat, and other autologous grafts used in surgical

nasal augmentation. In recent years, the xenograft Permacol has also been used for nasal augmentation in the UK [2]. With a nonsurgical approach, it is essentially an augmentation rhinoplasty; so it has limitations compared to a surgical rhinoplasty. Various properties of the commercially available calcium hydroxyapatite media (CHM), Radiesse® (BioForm Medical, San Mateo, CA) are discussed with its uses for nonsurgical rhinoplasties and avoidance of pitfalls. Attention is focused on Radiesse® (Fig. 56.1) because of its longevity, ease of administration and molding, as well as its excellent safety profile.

G.J. Bitar ( )

Assistant Clinical Proferssor, George Washington University Medical Director, Bitar Cosmetic Surgery Institute, 3023 Hamaker Ct, #109 Fairfax, VA 22031, USA

e-mail: georgebitar@drbitar.com

O. Osunsade

George Washington University School of Medicine

and Health Sciences, 1121 Arlington Blvd. #702, Arlington, VA 22209, USA

e-mail: olalesi@gwmail.gwu.edu

A. Devabhaktuni

George Washington University School of Medicine

and Health Sciences, 1111 25th St NW #509, Washington, DC 20037, USA

e-mail: ardevabh@gwmail.gwu.edu

Fig. 56.1 Radiesse® Syringes (Used with permission of Bioform Medical, San Mateo, CA)