hi my name is Dr zanab al- muktar I'm an advanced aesthetic injector and an aesthetic injectables trainer and today I'm going to be demonstrating non-surgical rhinoplasty with first the importance of scanning in order to map out the position of vessels before injecting we will start with the radex of the nose this is a particularly high-risk area and it's really important that we are aware of the position and depth of the vessels in this region so first I have Mar marked out the different zones of the nose the areas I will not be injecting the areas I'm considering injecting and a line of symmetry across the midline extending right from the gabella down to the colella region and indeed the chin this is to help me maintain a consistent view of the midline no matter where I'm standing we can see in B mode the different layers here in the radic the epidermis the dermis the subcutaneous layer the muscle layer and deep fat layer and we can see a nice white hyper aoic line which is the periosteum uh this view is very interesting because it shows us that there is a vessel that's running through different layers but that it could be extending quite deep possibly submucosal and potentially just grazing the bone and I'm going to move my color box up there appears to be different vessels or vessels showing in different layers in a deep layer as well as in the subcutaneous layer quite big this is the midline and when we look at tilting to one angle it looks like this that is quite vascular as I come to the right hand side it gets a little bit quieter but it's still present H this is exactly in the point that we want to inject okay so the different tilting motions of the probe reveal a lot more about the blood flow here so we start to see an appearance of vessels right so we have the beginning of the Redix there just before the dorsal hump where it looks like it's in a superficial plane and then as we go higher up into the redx The Vessel courses through the layers deeper it gets clearer and clearer the longer we leave the ultrasound there okay let's look at the transverse view this is the transverse view of the Erics capture video you can see considerable amount of blood flow which sometimes is quite nice to see question is how deep are those vessels are they touching the bone this is most likely to be is the interanal vein but also potentially you can see pulsating of the dorsal nasal arteries laterally just there in the center of the screen now is likely to be the dorsal nasal artery pulsating when we release pressure and come up the color box comes up and we can see potentially that might be a the interanal vein because when we compress it it seems to disappear which is classic of what happens with veins when they are compressed they collapse but arteries do not not sure I want to inject there that's exactly where we are now is the capture video so I saw vessel just touching the bone there there so that's an area I would not recommend injecting on bone nor can we inject subcutaneously because we also have subcutaneous vessels okay now we've done that let's look at the tip of the nose right in the middle there what do we see capture video this is the transverse view of the nasal tip where again we can see where we can see the cartilagenous domes and we're looking for the position of the vessels relative to those domes do A sagittal view the midline markings are now helping me because the gel wipes off a lot of the markings on the nose but I can remain in the mid line through the reference point I've created along the filtrum and the CH and indeed the gabella sagittal view of the nose this is an angel tip still looking for vessels I want to see a little bit more of a predictable appearance repeatable appearance there's something there so you can see here this is super tip Notch where the lower lateral cartilage begins to see a vessel sitting just above the position of the cartilage it's potentially missable with filler small amount of filler to bypass that nothing seems to be sitting right on the cross page capture video okay I'm okay with injecting that with a very small amount but is there any need to inject that unless we're doing the full nose so we have to come back to the tip and decide if it's safe the top part was very vascular and not really very safe to inject up here the tip of the nose was a bit safer I know that the top part is an important part for you the question is now do you still want to inject the tip of the nose if we're not going to mask the bump no okay
