The use of dermal fillers for a nonsurgical rhinoplasty requires a medical knowledge of nasal anatomy. The deep fatty layer is targeted as it is known as the safe plan for filler deposition. Therefore, the filler should be injected exactly underneath the fibromuscular layer and above the perichondrium/periosteum layer in order to avoid a superficial injection or an inaccurate injection into the nose's major blood vessels and artery systems [1– –5]. The advantages of a calcium hydroxyapatite filler used for nose sculpt arise from its ability to alter the shape of the nose at the anatomic region where it was positioned [6–8]. Also, when injected directly, the filler has the ability to correct aesthetic deformities without having the patient go through a complicated rhinoplasty procedure [9,10]. Moreover, it can also be used for the correction of postrhinoplasty deformities .
The dermal filler of choice used in this study was Crystalys, a calcium hydroxyapatite injectable filler (Panaxia Ltd.). Crystalys is a sterilized, apyrogenic, long lasting and non-permanent injectable facial implant. It is a homogenous, semi-solid implant, intended for sub- and deep-dermal use, it is provided in a 1.25 mL pre-filled graduated, glass syringe. The filler is based on synthetic calcium hydroxyapatite, the major material of teeth and bones . It consists of microspheres of calcium hydroxyapatite formulated to a concentration of 55.7% CaHA, suspended in an aqueous gel carrier of glycerol and sodium carboxymethylcellulose. When injected, the CaHA microspheres form a framework for ingrowth by fibroblasts, which steadily substitute the carrier vehicle.