Step by Step Nasal Tip Rhinoplasty

Using Endopeel Techniques

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Step 1

Desinfection without any alcoholic product

We use sterile monouse sheets made with the amide of citric acid, called Aseptiderm.

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Step 2

Position of the Patient

It has to be in dorsal decubitus and head in hyperextension with bestens a pillow under the neck.

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Step 3

Position your left hand : 5 th finger on the supra tip

The goal is to lift now the columella which has to be absolutely without any angulations, parallel to the OP bed.For that you need to position your left hand with 5 th finger on the supra tip.

Left hand is used to position the nose

Right hand is used to inject.

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Step 4

Position your left hand : 2 nd finger in the left nostril

Without moving your 5 th finger which is on place on the supra tip, introduce your 2 nd finger in the left nostril.

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Step 5

Position your left hand : 1 st finger or thumb in the right nostril

Without moving your 5 th and 2 nd finger which are well positioned, the 1 st finger or thumb has to be in the right nostril, so that it s now easy to lift the columella to make it parallel to the OP bed.

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Step 7: Marking the barycenter of the philtral triangle

The most declive point inside the philtral triangle is the barycenter and should be marked

 See the red point on the picture.

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Step 8: 1 st injection in the philtral barycenter

normal at 90 grades with the philtral plan directly to the barycenter

Without moving the fingers from left hand and putting the 5 th finger of the right hand under the middle of the chin ,Injection has to be perpendicular to the philtral plan in the barycenter.Normally 0.15 ml are enough.Respect carefully the material which needs to be used like here

-1 sheet Aseptiderm or a not alcoholic desinfectant.
-1 Syringhe BD 1 ml luer lok
-1 needle BD 30g1/2
- 0.15 ml for 1st injection or 1 1/2 graduation from the ampoule DocTNB ( other products lead to irreversible complications like necrosis)

NB Local Anaesthesic Gel  ( 1 ml) is recommended to put on the philtral triangle at least 1/2 min before the injection 

 

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Step 9: 2nd injection at the intersection of the philtral bands

doing 30 grades with the philtral plan ( horizontal) up direction

Without moving the fingers from left hand

The Injection has to make a 30 grades with the philtral plan into the intersection of the philtral bands and towards the caudal muscle of the nasal septum whih is very thin.

Normally 0.15 ml per injection point are enough.Respect carefully the material which needs to be used like here

-1 sheet Aseptiderm or a not alcoholic desinfectant.
-1 Syringhe BD 1 ml luer lok
-1 needle BD 30g1/2
- 0.15 ml for 1st injection or 1  1/2 graduation from the ampoule DocTNB ( other products lead to irreversible complications like necrosis)

NB Local Anaesthesic Gel  ( 1 ml) is recommended to put on the philtral triangle at least 1/2 min before the injection 

At the end we have hust used 2 injections of 0.15 ml to lift the nasal tip.

 

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Step 10: Immediate Final Result

The nasal tip is perfect

 Duration : 6 months just with 2x0.15 ml = 0.30 ml.