The author presents a brief account of some key messages to practitioners undertaking non-surgical nose augmentation using calcium hydroxylapatite (Ca HA); reinforcing a robust, current and accurate knowledge of facial anatomy as well as the established safety profile of CaHA. Reference is made to ‘compelling’ evidence to support embolic phenomenon as the only cause of vascular compromise following dermal filler placement, yet no formal source(s) are acknowledged. Furthermore, the author challenges that 0.1ml of dermal filler, also extracted from a ‘research based guideline’, is deemed insufficient to travel retrograde into the internal carotid artery and thus, the retinal artery, which lacks important anatomical detail for the reader, such as the anterograde path to the retinal artery. The article does convey the importance of appropriate and timely use of hyaluronidase in the context of hyaluronic acid dermal fillers, alluding to the ambiguity surrounding dosing and required skill of the practitioner in utilising this agent. An interesting account, which draws on crucial safety aspects pertaining to non-surgical enhancement of the nose.

Hyaluronidase is not a foolproof safety net for injectors and prevention is key.
Collier H.
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Anna Baker

BJN Aesthetic Nurse of the Year 2016.

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