Offering Profiloplasty

Profiloplasty is a form of treatment that enhances the profile of a patient. This procedure is non-surgical and results in a more harmonious and balanced appearance. A dermal filler is used for chin augmentation, rhinoplasty, and occasionally for lip enhancement with the goal of balancing the proportions of the face. Patients seldom realize how greatly all of their facial features influence the appearance of their nose and face in general, and they will often focus on their one dominant aesthetic feature.

Plastic surgeon Dr. Mario Gonzalez-Ulloa has theorized about the ideal chin-nose ratio. A standard that he uses involves drawing one line perpendicular to the horizontal line of the Frankfurt horizontal plane and tangential to the nasion. According to him, in a face with ideal proportions, the most projecting point of the chin should be on the line or just posterior to it. 

The Treatment

Profiloplasty can enhance the profile of a patient and help them avoid the trauma, scarring, and the high costs of surgery. However, it is important that an assessment of the full face is completed prior to this procedure being carried out. Dr. Yusra Al-Mukhtar recommends opting for dermal fillers with high volumizing capacity and a high G prime. Along with being highly cross-linked, such dermal fillers can provide great longevity.  Additionally, local anesthetic assists in correcting otherwise sensitive areas and adds to patient comfort.

The main component of the procedure is strategic injections of dermal filler into the nose to hide the dorsal hump. This will straighten the bridge of the nose, elevate the tip, and ultimately shorten its appearance. Correct chin size and posture—including anterior projection, length, and symmetry—are essential to achieving an aesthetically pleasing result after the procedure. A chin with an inadequate projection can cause the nose to appear much larger than it is, so it is important to achieve a balanced proportion between the chin and nose. The adjusted profile mimics aesthetically correct skeletal structures.

Side Effects and Complications

The contraindications to this procedure are similar to that of other dermal filler treatments. Profiloplasty should not be performed on pregnant patients, breastfeeding patients, patients that have a suppressed immune system, and patients that are prone to keloid scarring. It is also important for patients’ expectations to be managed. For example, if they have a large nose, dorsal hump, or severe skeletal base, it may be more optimal to undergo surgical procedures; in these cases, patients should be counselled accordingly.

The side effects of this procedure are usually limited to swelling and bruising, and these can take between one to four weeks to settle. The chin will be especially tender, and swelling of the local muscles can cause a feeling of stiffness. Patients may use over-the-counter analgesics to manage their pain. Serious complications such as infection or necrosis are rare but may also occur. Patients should be advised by their practitioner to avoid touching the treated area(s) and not apply makeup for at least 12 hours. Necrosis due to vascular occlusion is a rare but very serious complication. The risk of this is reduced when patients see an experienced practitioner who has an excellent understanding of local anatomy and knows to follow safe injection techniques.

Dr. Yusra suggests that practitioners should, prior to injecting, aspirate to check if the needle they are using is in a blood vessel. Additionally, they should make sure the injections are deep and close to the bone or cartilage, and they should inject the filler slowly and in small increments. Any signs of occlusion, such as blanching of the skin, should be treated immediately. This may be done by dissolving the filler with hyaluronidase. Patients should also be advised to return for urgent treatment if they find that they have any ulcerations, blistering, or any changes occurring in skin color. The nose is one of the higher risk areas to inject due to vasculature, and this risk should be discussed with patients. 

Conclusions

Profiloplasty is a non-invasive treatment modality that can enhance the facial profile of a patient while allowing them to avoid the trauma, scarring, and high costs associated with conventional cosmetic surgery. It is suitable for class II skeletal patients who would like to enhance the appearance of their facial profile, and the results can last between 12 to 18 months, depending on the filler used. Patient expectations should be managed, and they should be advised of any risks; however, with an experienced injector that uses safe injection techniques, the risks can be minimized. Ultimately, the end result of a successful profiloplasty procedure is a more harmonious, balanced, and aesthetically-pleasing facial profile.