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Chu et al. Plast Aesthet Res 2020;7:73 I http://dx.doi.org/10.20517/2347-9264.2020.169 Page 3 of 8
Figure 1. Injection site is created with a 23-gauge needle
Figure 2. 22-gauge microcannula insertion through the injection site
Understanding the anatomy of the nose is critical to minimizing the risk of complications and optimizing
the aesthetic outcome. From superficial to deep, the four layers that comprise the nose are the superficial
[14]
fatty layer, the SMAS (superficial musculo-aponeurotic system), the deep fatty layer, and periosteum . The
superficial fatty and SMAS layers contain major blood vessels of the nose. To minimize and avoid vascular
occlusion, skin necrosis, and blindness, filler injections should be delivered into the deep fatty layer, which
is between the SMAS and the periosteum. In regards to the dorsal nasal artery, it is imperative that the
injector verifies that the tip of the cannula is in the preperiosteal plane. This helps to avoid accidental
arterial cannulation which can often lead to serious ocular complications .
[15]
