Novel Ultrasound-Assisted Nonsurgical Rhinoplasty Technique: Injection Guidelines From Evidence to Clinical Practice Based on 4400 Procedures.

[BACKGROUND] Nonsurgical rhinoplasty has gained popularity as a minimally invasive alternative to surgery; however, the nasal region's complex and variable vascular anatomy has led to a significant increase in complications. This underscores the need for a standardized, anatomy-based injection protocol supported by clinical evidence.

[OBJECTIVES] The objective of this study was to evaluate the efficacy and vascular safety of a structured injection protocol for nonsurgical rhinoplasty using hyaluronic acid, guided by real-time Doppler ultrasound in Latin American patients.

[METHODS] The protocol included preinjection Doppler mapping, aspiration testing, and anatomically specific filler volumes. Real-time ultrasound guidance verified filler placement.

[RESULTS] Among 365 positive aspirations (8.3%), 73.97% occurred at the anterior nasal spine, yet no vascular occlusions were observed in this region. Twenty vascular events (0.45%) were recorded-18 in the nasal tip and 2 in the columella-all resolved without sequelae using a high-dose hyaluronidase protocol. Optimal outcomes were achieved with 0.2 mL in the nasal spine and columella and 0.15 mL in the tip. At baseline, 96% of patients rated outcomes as "Very Improved," decreasing slightly to 89% at 2 weeks.

[CONCLUSIONS] This Doppler-guided, stepwise protocol demonstrated high efficacy and low complication rates in high-risk nasal zones. The findings support the routine integration of ultrasound and anatomically tailored injection techniques to enhance safety and reproducibility in nonsurgical rhinoplasty.