Westernization of the Asian Nose by Augmentation of the Retropositioned Anterior Nasal Spine With an Injectable Filler

Objective: The aging nose presents as a drooping nasal tip secondary to atrophy of the underlying bony support with a relatively prominent dorsal hump. We hypothesized that low nasal tip projection in the Asian nose may be secondary to the retropositioned anterior nasal spine (ANS) as well. Therefore, we investigated how filler injection between the medial crura and the retropositioned ANS affects the nasal shape. Methods: Local anesthetic was injected on the ANS for analgesia and simulation for the following augmentation. To augment the retropositioned ANS, approximately 0.3 to 0.5 mL of injectable hyaluronic acid was injected between the footplates of the medial crura and the ANS. We evaluated 30 patients (29 women and 1 man) ranging from 21 to 71 years of age (36.5 ± 7.2 years) before and after the augmentation. Results: Augmentation of the retropositioned ANS significantly decreased nasal width, but increased alar length, nasal tip protrusion, inclination of the nostril axis from the horizontal, and columellolabial angle (P < .0001). Conclusion: Our findings indicate that augmentation of the ANS elongates the pseudocolumella, lifts the medial crura, and affects the whole nasal shape. Consequently, augmentation of the retropositioned ANS with an injectable filler westernized the Asian nose. This temporary method may be useful to predict the results of ANS augmentation with other permanent fillers and to make a space to be filled with them.