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Surgical Technique |

Calcium Hydroxylapatite Gel (Radiesse) Injection for the Correction of Postrhinoplasty Contour Deficiencies and Asymmetries

Howard D. Stupak, MD; Thomas H. M. Moulthrop, MD; Patricia Wheatley, RN, MSN; Allison V. Tauman, PharmD, MPH; Calvin M. Johnson Jr, MD
Arch Facial Plast Surg. 2007;9(2):130-136. doi:10.1001/archfaci.9.2.130.
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Objectives  To describe our technique for the injection of calcium hydroxylapatite gel (Radiesse) to treat postrhinoplasty contour defects and to evaluate the agent's efficacy, duration of action, required dosage, complication rates, and patient satisfaction. Slight defects or asymmetries are not uncommon, even after well-executed rhinoplasty surgery in the most expert of hands. These contour deformities have been treated with filler agents in the past, but with mixed results. Calcium hydroxylapatite gel was recently introduced as a filler agent in facial plastic surgery, but its use has not yet been described in the correction of postrhinoplasty nasal contour defects.

Design  A prospective before-and-after trial conducted in a private-practice facial cosmetic surgery office. Eligible patients had postrhinoplasty contour irregularities or asymmetry. Postrhinoplasty irregularities at the nasal dorsum or tip underwent subcutaneous injection with calcium hydroxylapatite. Main outcome measures included number of treatments, posttreatment injection pain score, required dose and complications, natural feel, patient satisfaction, and length of follow-up. Digital photographs were evaluated by blinded observers.

Results  Thirteen patients were followed up prospectively for a mean of 2.5 months. The mean injection pain score was 1.9 (scale, 0-5); the mean dose, 0.19 mL. Patient satisfaction was good to excellent in 11 (85%) of 13 cases. Photographic improvement was seen in 15 (88%) of 17 treatment sites.

Conclusions  Calcium hydroxylapatite gel has been shown in this study to improve postrhinoplasty nasal symmetry and smooth the curves and lines that constitute the contour of the nose. The longevity of nasal augmentation by calcium hydroxylapatite remains unsettled; long-term safety is also unknown. Long-term studies of safety and efficacy are indicated.

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Figure 1.

Frontal view of a patient before (A) and 6 months after (B) injection of a total of 0.2 mL of calcium hydroxylapatite (Radiesse; BioForm Inc, Franksville, Wis) to her bilateral nasal sidewalls. Particular attention can be paid to the narrowed middle portion of the nose (arrow).

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Figure 2.

A patient 10 years after rhinoplasty with a relative saddle nose deformity and supratip depression before (A) and immediately after (B) an injection of 0.2 mL of calcium hydroxylapatite (Radiesse; BioForm Inc, Franksville, Wis) to the dorsum, 1 month after calcium hydroxylapatite treatment (C), and immediately after a second injection of 0.2 mL of calcium hydroxylapatite (D).

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Figure 3.

Oblique magnified (×2) view of 1-year postrhinoplasty slight alar depression (arrow) (A) and 5 months after injection of 0.1 mL of calcium hydroxylapatite (Radiesse; BioForm Inc, Franksville, Wis) to the alar depression, demonstrating improved contour (B).

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Figure 4.

Lateral view of a female patient with a saddle nose deformity due to polychondritis (A) and 3 months after injection of calcium hydroxylapatite (Radiesse; BioForm Inc, Franksville, Wis) to the nasal cartilaginous dorsum, with marked improvement (B).

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