You probably know Cesc Escolà as the fitness trainer on Operación Triunfo or from the TV program Muévete en casa, where he encouraged people to stay fit at home during the coronavirus pandemic. Like many others, Cesc was not happy with his nose and therefore chose Clínica Planas to address his concern.
What recommendations can we give to patients with previous hyaluronic acid treatments?
If this is your case and, like Cesc Escolà, you were unhappy with your nose and chose to correct it with hyaluronic acid—but the result was not what you expected—and you are now considering rhinoplasty as a solution, there are some important recommendations to keep in mind before surgery.
Hyaluronic acid is a resorbable material, but not completely. Even a year after application, the central part of the filler is more difficult to absorb than the peripheral areas. Therefore, if a significant amount was injected, some product will almost always remain.
In addition, in some cases complications such as granulomas may occur. This means that a small capsule can form around the product, although this is rare and uncommon.
Regarding recommendations: six weeks prior to rhinoplasty surgery, the filler should be dissolved. This is done using an enzyme called hyaluronidase. Depending on the anatomical location of the hyaluronic acid, dissolving it may be more or less advisable. For example, if filler has been injected in the glabellar area (between the eyebrows), it is more difficult to access. In such cases, hyaluronidase is very helpful because, once dissolved, it no longer masks the anatomy and clearly reveals what the patient dislikes, allowing the surgeon to determine exactly which modifications are needed.
On the other hand, when hyaluronic acid has been injected into the nasal tip, it is often easier to remove the product directly during surgery due to the proximity of the incision.
In any case, Dr. Ramón Tarragona recommends the use of hyaluronidase in most cases to achieve better and more predictable surgical results.
What is ultrasonic rhinoplasty?
Ultrasonic rhinoplasty focuses on treating the bony structure of the nose. The cartilaginous part is addressed using elevators, cutting techniques, sutures, or by modifying the relationship between angles. However, the bony part of the nose—usually the dorsal hump and the width of the nasal bridge—was traditionally fractured using aggressive and relatively imprecise instruments.
Today, with ultrasonic rhinoplasty, the bone is not broken but precisely cut using an ultrasonic system, which also irrigates with water to cool the area and prevent overheating of the bone. These ultrasonic vibrations allow for a much more accurate cut, acting only on hard tissue and not on soft tissue. As a result, the mucosa and blood vessels are not damaged, leading to less blood leakage and fewer bruises.
Is rhinoplasty or rhinomodeling better?
You may have heard of someone who chose rhinomodeling before deciding to undergo rhinoplasty, often with disappointing results. The truth is that these are two completely different procedures, and each has its own specific indication.
Rhinomodeling is performed using hyaluronic acid and is intended to fill depressions or hollow areas.
If there is a defect on the nasal dorsum—or if one side of the nose is more sunken than the other—filler can be injected to create the illusion that the nose is straighter or less deviated. However, when trying to mask large prominences on the nasal dorsum, a problem arises: since the nose often begins high on the forehead, adding filler increases its overall size. This creates a contradiction, as most patients seeking rhinomodeling want their nose to appear smaller, not larger.
In short, hyaluronic acid is useful for filling small defects.
Rhinoplasty, on the other hand, is used to reshape the nasal dorsum—to make it smaller, straighter, to support and rotate the tip—in short, to correct everything about the nose that the patient is unhappy with.
One very interesting aspect is the use of hyaluronic acid after rhinoplasty.
No nose is ever absolutely perfect, and even after significant improvement, there may be small details a patient doesn’t fully like. In such cases, hyaluronic acid can be very effective, as only a small amount is needed to fill a minor depression and achieve an optimal final result through the combination of both techniques.
Rhinoplasty: Cesc Escolà’s surgery and postoperative recovery
Objective of the surgery
As mentioned at the beginning of this post, Cesc Escolà was not satisfied with his nose due to a series of deviations that bothered him aesthetically. He initially chose hyaluronic acid injections (rhinomodeling) to mask these deformities and irregularities.
While this may have partially corrected the deviation, the nose became larger and wider due to the fillers. After undergoing rhinomodeling, he still did not feel comfortable with the result, as hyaluronic acid only masked the deviation and required repeated injections over time. For this reason, he sought a definitive and permanent solution at Clínica Planas, under the care of Dr. Ramón Tarragona.
Type of surgery performed
One of the challenges we encounter in patients who have previously had hyaluronic acid injected into the nose is the presence of increased fibrosis. When filler is injected, the tissue heals and the body reacts, meaning that a nose that has been previously treated is not the same as one that has never been touched.
Additionally, hyaluronic acid creates a mass effect, weakening the ligaments of the nasal tip and making them softer, as well as the cartilage itself. The space occupied by the filler places pressure on the tissues, causing them to lose strength. These were precisely the issues we encountered in Cesc Escolà’s case.
The first step was to remove the filler as well as the existing fibrosis. Once this was done, we observed that the underlying structure beneath the skin—the bone and cartilage that were present before the hyaluronic acid—was significantly deviated, irregular, and had multiple imperfections.
To correct this, we reshaped the internal framework using cartilage grafts taken from his own septum. There was also asymmetry in the nasal bones, with one side wider than the other, so asymmetric cuts were performed on both sides to realign the nasal pyramid along the midline.
Postoperative period
The surgery resulted in very satisfactory outcomes, with a smooth postoperative course and no complications.
Final result
Cesc Escolà achieved a permanent correction of the nasal deviations and the widening caused by previous hyaluronic acid injections, resulting in a nose that is harmonious with his facial features.
