Because facial symmetry has long been perceived as aesthetically desirable, a crooked nose can be problematic. Deviation of the nose can occur at the upper dorsum, lower dorsum, and tip, and often some combination of all 3.
Straightening the nose with filler is quite straightforward. The filler can be placed on the concave side of the nasal bones or middle vault. The filler is effectively being used to create a spreader graft. Because this may widen the dorsum, proper patient selection (those with a thinner dorsum), frank counseling, and computer imaging can help.
Correction of a premaxillary deficiency is another useful application of nonsurgical rhinoplasty. The product is placed is deep on the maxilla. The needle should enter through a medial location, at the junction of the ala and the upper lip, rather than laterally, where the ala meets the cheek. The marginal and lateral nasal arteries are at risk with a lateral introduction. Aspiration of the 29-gauge needle when upon the periosteum of the maxilla is advisable before injection. Approximately 0.2 to 0.3 mL of filler is needed, depending on the degree of premaxillary deficiency. This placement is generally done unilaterally to straighten the tip, although bilateral placement could be done in patients with an underdeveloped, retrusive maxilla