Received: 3 August 2020 Revised: 20 February 2021 Accepted: 12 May 2021

DOI: 10.1111/dth.14989

ORIGINAL ARTICLE

Our experience with lipofilling in secondary rhinoplasty, into a

new era

Raymond Challita1 | Ziad Sleiman1 | Nagham Bazzi2 | George Ghanime1,3

1
Department of Plastic & Reconstructive
Surgery, Faculty of Medical Sciences,
Lebanese University, Beirut, Lebanon
2
Faculty of Medical Sciences, Lebanese
University, Beirut, Lebanon
3
Head Division, Department of Plastic &
Reconstructive Surgery, Lebanese University
Hospital Geitawi, Beirut, Lebanon
Correspondence
Raymond Challita, PGY5, Plastic &
Reconstructive Surgery, Faculty of Medicine,
Lebanese University, Lebanese University
Hospital Geitawi, Beirut, Lebanon.
Email: raychallita@gmail.com
Abstract
Rhinoplasty is a commonly performed cosmetic surgery. Clinicians are facing an
increased demand on non-surgical procedures, therefore liquid rhinoplasty is gaining
popularity. Given the characteristic of lipofilling to rejuvenate and improve skin tex-
ture, fat grafting can be used to reshape the nose in secondary rhinoplasty. Fat was
injected in 27 patients with a mean age of 42 years. Volume of fat ranged from 1.5
to 4.5 cc with a mean of 2.2 cc. Patients were seen at 1 week, 3 months, 6 months,
and 1 year. Patient satisfaction was measured using the Rhinoplasty Outcome Evalu-
ation questionnaire and plastic surgeons' evaluation. After 1 year follow up,
20 patients were satisfied with the results at 1 year. The aesthetic outcome was
noted as very good in 11 patients, good in 9 patients, and poor in 3 patients. Most of
the patients had an improvement in skin texture with trophic effect on the skin. No
complications were seen in our series According to this study, nasal lipofilling is a safe
and efficacious filler in secondary rhinoplasty. However, more studies are needed to
assess the indications and limitations of nose lipofilling.

KEYWORDS
non-surgical rhinoplasty, nose fat filling, regenerative medicine, revision rhinoplasty

1 | I N T RO DU CT I O N nose deformity.5 Even though surgery is the first choice in

Rhinoplasty is a common and popular aesthetic procedure performed
1
worldwide. It continues to rank among the top five cosmetic surgical
procedures performed in 2019. According to the statistics of the
American Society of plastic surgeons, 207 284 rhinoplasties were per-
formed in 2019.2
In 1880, Lipofilling was used for the first time in reconstructive
surgery to correct facial deformities, to reconstruct defects post onco-
logical surgery, to treat complex wounds, and to manage scars.3 It was
also utilized to correct nasal Malformations in Hallerman–Seriff syn-
4
drome. Therefore its usage is increasing widely and particularly in
4
maxillofacial and plastic surgeries.
Nowadays we are in the middle of a new era of rhinoplasty, in
which non-surgical rhinoplasty is gaining popularity in the interest of
its fewer side effects, shorter interventional time, and rapid recovery
time when compared to surgery. In the nineteenth century, non-
surgical rhinoplasty was performed for the first time to treat saddle
rhinoplasty,6 recent studies showed that non-surgical techniques can
be a reliable alternative for rhinoplasty especially in secondary rhino-
plasty.6,7 And by offering these techniques physicians are providing
patients with less invasive, more economic, and an alternative tech-
nique for non-surgical candidates.8
The regenerative properties of fat grafts has been always an
evolving paradigm and a subject of intense research. Fat grafting
restores youthful appearance and possesses regenerative properties
by the stimulation of collagen neosynthesis.9 Skin rejuvenation can be
the result of the trans-differentiation of pre-adipocytes cells present
in the adipose tissue to epithelial stem cells.10
Thus lipofilling is a potential filler of reference for rhinoplasty.11
And it can be performed on the dorsum, radix, glabella, pre-maxilla,6
and nasal pyramid.11
Despite the increasing demand for non-surgical techniques in rhi-
noplasty, only few articles discuss nose lipofilling in secondary rhino-
plasty. Moreover, nasal fat grafting is still an uncommon procedure

Dermatologic Therapy. 2021;e14989. wileyonlinelibrary.com/journal/dth © 2021 Wiley Periodicals LLC. 1 of 7

https://doi.org/10.1111/dth.14989
2 of 7 CHALLITA ET AL.

when compared to facial lipofilling and to other nasal synthetic fillers

like Hyaluronic acid.11 This retrospective study aims to review our
practice with nose lipofilling in a private plastic surgery clinic in Beirut,
Lebanon, in treating rhinoplasty sequelae and aims to identify the
effectiveness and the safety of this procedure.

2 | MATERIALS AND METHODS

We conducted an observational retrospective study from 2012 to

2020 for patients seeking secondary rhinoplasty.
Inclusion criteria included: Patients operated at our clinic using
lipofilling for the correction of a secondary deformity post rhinoplasty.
Exclusion criteria included patients who have undergone any sur-
gical or aesthetic procedure to correct their deformity in the
past year.
A total of 27 patients were included. Injected areas depended
solely on patients' complaints. All patients were informed that their
images might be anonymously used for scientific purposes at a later
stage and their consent was obtained. Moreover, the principles out-
lined in the Declaration of Helsinki were followed and respected.
Fat cells harvest was done under local anesthesia from areas with
fat excess like: the abdominal area, flanks, thighs, and knees. The most
common donor site was the lower abdominal area with two patients
benefiting from the flank area.
Infiltration was done with 20 cc of xylocaine 1% with adrenaline F I G U R E 1 External entry points (bleu x) and cannula pathways
1:100 000 diluted with Normal saline. Fat was harvested by manual (black arrows) for the nasal zones to be corrected. The plane of
injection: Supraperiosteal
suction using a 3 mm diameter Coleman cannula connected to a 10 cc
syringe. Fat cells were then prepared and filtrated using a funnel. Pure
fat cells were subsequently inserted into multiple 1 cc syringes and 3 | RE SU LT S
injected using a 1 mm diameter Coleman cannula.
The entry points were made with a blade (number 11) after apply- A total of 22 female and 5 male patients were included in this study.
ing local anesthesia (xylocaine 1% with adrenaline 1:100 000). Entry These patients were operated for the correction of nasal deformities
points depended on the zone to be corrected. For nasal dorsum injec- post primary rhinoplasty. The nasal deformities treated were as fol-
tion the internal or external approach was used. In the internal low: 12 patients were operated for dorsum irregularities, 3 patients
approach used a small incision in the intercartilagenous area for the were operated for a V deformity, 8 patient for saddle nose deformity,
cannula insertion. In the ⁣external approach we used supratip or lat- and 4 patients for visible osteotomy lines. To note that 4 patients
eral nasal entry points (Figure 1). The plane of injection was the supra were lost in the follow up.
periosteal layer. The patients were seen at 1 week, 3 months, The mean age of the patients was 42. The amount of fat injected
6 months, and 1 year. ranged from 1.5 to 4.5 cc with a mean of 2.2 cc. Patients were seen at
Patient satisfaction was measured using a modified “rhinoplasty 1 week, 3 months, 6 months, and 1 year. A total of 19 patients
outcome evaluation questionnaire” (ROE) in which the breathing benefited from one procedure. The other 8 patients received a second
parameter was omitted and the final total score was 20. The modified lipofilling session at 6 months.
questionnaire has five questions, with five answer options, graded Patients' satisfaction was measured after 1 year. Twenty patients
from 0 to 4.12 The questionnaire assesses the patient's satisfaction were satisfied with the result (Figures 2–4). The ROE mean score was ini-
with the appearance of the nose, degree of confidence, social interac- tially 8.65 ± 2.17, and 14.82 ± 3.29 at 1 year post nasal fat filling (Table 1).
tions, professional limitations, and desire to alter the appearance of The aesthetic outcome ranged from very good in 15 patients,
the nose. The end result was the patients' total level of satisfaction, good in 5 patients, and poor in 3 patients. To note that a second
the improvement in ROE score, and plastic surgeons' evaluation at lipofilling session was needed in patients suffering from a severe sad-
1 year. Patients noted if they are satisfied or not. Finally, the aesthetic dle nose deformity (Figure 5). The three poor results were observed in
result was rated as very good, good or poor by two plastic surgeons two patients with saddle nose deformity and in one patient with visi-
after comparing pre and post-operative photos. ble osteotomy lines and a nose deviation.
CHALLITA ET AL.
F I G U R E 2 Patient treated for dorsal
irregularities (A). A one session of fat filling with
1.5 cc of fat injected. The results seen are at
1 year post op (B)
F I G U R E 3 Patient treated for dorsal
irregularities (A). A one session of fat filling with
2 cc of fat injected. The results seen are at 1 year
post op (B)
Additionally, most patients remarked a skin texture improvement.
No complications other than mild ecchymosis and edema were
reported in our series. And a low fat resorption rate was proved by
the number of patients requiring another procedure.
4 | DISCUSSION
Nowadays, patients seek more non-surgical and noninvasive proce-
dures. Thus not surprisingly, liquid rhinoplasty is gaining popularity.
Despite this increase in the demand on soft tissue fillers, an ideal filler
has not been yet discovered with various side effects witnessed with
the currently used products.13 When used in the nasal area adverse
reactions like ecchymosis, hematoma, nodule formation, local skin
3 of 7
reaction, infection, and filler migration can occur.14 Despite this fact,
the use of hyaluronic acid and calcium hydroxyapatite injections in
nose filling is still common.12 According to Williams et al. Hyaluronic
acid is the most common filler used in non-surgical rhinoplasty14
Meanwhile, the use of autologous fat in the nasal area is still not pop-
ular, although it can be considered a safe, permanent, and a simple
autologous procedure.15
Fat grafts have the ability to enhance skin texture and quality which
was expressed by most of the patients in our study. To note that various
studies in the literature also described the regenerative properties of adi-
pocytes derived stem cells (ADSC). This was consistent with Kao et al.
study that enrolled 198 Asian patients for nasal dorsum augmentation
with fat. At the end of the procedure, most patients achieved an
improvement in their skin texture, nasal wrinkles, and in skin pores. Add
4 of 7 CHALLITA ET AL.

F I G U R E 4 Patient treated for visible

osteotomy lines and dorsal irregularity (A, B). A
one session of lipofilling was done. 1.5 cc of fat
were injected on each side and 1.5 cc injected on
the nasal dorsum. The results seen are at 1 year
post op (B, D)

T A B L E 1 The mean values of ROE

Deformity N ROE mean pre Fat filling Mean ROE at 1 year
pre and post lipofilling according to the
Dorsal irregularities 10 9.3 ± 1.1 16.2 ± 0.87 deformity treated
V deformity 3 7 ± 2.16 12.6 ± 4.02
Saddle nose 7 7.14 ± 1.8 12.71 ± 3.95
Visible osteotomy lines 3 11.66 ± 1.24 17.33 ± 0.47

Abbreviations: N, number of patients; ROE, rhinoplasty outcomes evaluation.

to that, patients witnessed a fresher and shinier skin color.16 These
results are ensured by ADCSs that promote angiogenesis and improve
scar healing.17 However, there is a controversy whether the effect of
ADSCs is assured by their multi-lineage differentiation ability or by the
secretions of paracrine factors, exosomes, and cytokines that stimulate
18
skin regeneration. As a result, this treatment can be geared for cos-
metic purposes and skin disorders such as radiation dermatitis and
17
chronic ulceration. This property is not found in synthetic fillers.
The resorption of fat cells can be a limiting factor.15 The percent-
age of facial fat grafting survival is variable. With improved fat han-
dling, high survival rates of 83% with an average percentage of 47%
were attained with a range of follow-up of 3–24 months.19 This is in
contrast to synthetic fillers, especially hyaluronic acid where a tempo-
rary effect is present with the need of subsequent injections or touch
ups.14 Fat retention rate depends on both intrinsic and extrinsic fac-
tors. Intrinsic factors are related to the patient whereas extrinsic
CHALLITA ET AL.
F I G U R E 5 Patient treated for
saddle nose deformity (A). Two
sessions of lipofilling were done. The
first one 2.5 cc of fat were injected in
the dorsum. Another session was
needed at 6 months with the use of
another 1.5 cc of fat. The results seen
are at 1 year post op (B)
factors depend on the fat harvest technique, fat preparation, and the
20
injection method. Fat harvest technique has a higher survival rate
3
when performed in minimally invasive methods. There is a debate
between the effectiveness of four main techniques: vacuum aspira-
3
tion, syringe aspiration, and surgical excision. On the other side,
Kakagia et al. stated that surgical fat excision is better than fat aspira-
tion. Additionally, cannula size and holes' numbers play a pivotal role
in fat longevity. Erdim et al, proved that the viability of fat grafts
increased when fat was harvested with a 6 mm cannulas instead of a
17,21
4 or a 2 mm cannula.
However, in our series, we used the syringe aspiration technique
with a 3 mm Coleman cannula. Fat processing was done with funnel
filtration, and fat cells were injected in small aliquots. This technique
showed good viability of fat cells as proved by the low rate of second-
ary procedures at 1 year follow up. A second procedure was only used
in eight patients with severe saddle nose deformity. Fat Graft survival
is unpredictable, and less than predicted may be resorbed. Thus, a
larger sample and longer follow-up are needed to assess its longevity
and resorption. For this reason, we do not recommend an over-
correction of the deformity. Adipocytes' viability and activity also
22
depends on the fat donor site. Femoral sites have been proven to
have the greatest lipogenic activity, whereas facial fat had low adipo-
cytes activity.22
Finally, fat injection is preferably performed in multiple
small-volumes, using small-gauge cannulas to reduce ischemic and
3
bleeding risks and improve survival. In our practice, we used 1 mm
Coleman injection cannulas to deposit small fat parcels in a supra peri-
osteal layer.
Fat grafting is widely used in breast reconstruction to correct
breast shape after surgery.3 It's also proven to reduce scar contrac-
ture, promote wound healing, collagen deposition, neoangiogenesis,
and dermal hyperplasia in burned patients.3 It can be also used in
6,11
adjunct to a primary rhinoplasty, or as a unique treatment to
4,6
improve nasal aesthetics. Fat grafting can be also used as an alter-
native to secondary rhinoplasty in treating saddle nose deformity,11
5 of 7
lateral osteotomy sequelae,11 disinsertion of triangular cartilage or
nasal bone with inverted V deformation,11 dorsum irregularities
or nostril notches11 and in Hallermann–Streiff syndrome.4
Imperfections post rhinoplasty are common and a revision rhino-
plasty is indicated in certain cases. However it is not always feasible.18
Moreover, there is an increased risk of patient dissatisfaction in revi-
sion surgeries. This may be due to a change in the nasal anatomy, the
development of scar tissue, the loss of cartilaginous support,
the altered blood supply, and the compromised soft tissue envelope.23
Here comes the role of fat grafting which is a relatively simple and
safe procedure to camouflage nose imperfections as already discussed
by Baptista et al.11 To add to that the importance of lipofilling in
improving and remodeling scar tissue, in filling the subcutaneous tis-
sue, and in improving the skin quality post rhinoplasty.24 This may set
another indication for nasal lipofilling where nasal fat filling could be
used to improve and increase nasal soft tissue quality prior to second-
ary rhinoplasty to ameliorate the results of an already challenging pro-
cedure.11 This regenerative characteristic of scar remodeling cannot
be obtained with others synthetic fillers.
In a longitudinal study that used fat grafts to correct rhinoplasty
sequelae,11 the volume of fat injected ranged between 1 and 6 cc
according to the deformity corrected (dorsum irregularity, visible lat-
eral osteotomies and saddle nose) and to its severity.11 However, in
another study, fat volume depended on the presence of a complimen-
tary rhinoplasty in nasal reshaping.6 Fat harvested volume ranged
from 3 to 12 ml in lipofilling alone, and 6–12 ml of fat in lipofilling
complementary to rhinoplasty.6 In our study, our aim was to correct a
rhinoplasty deformity that was performed 1 year ago, thus the
amount of fat injection (1.5–4.5 cc) was close to the study where
lipofilling was done solely.
The first effect of lipofilling is volume augmentation.11 It also has
the ability to reduce nasal deformities and ameliorate respiration dur-
ing sleep (a functional gain) in Hallermann–Streiff syndrome.4 Patient
satisfaction after lipofilling for aesthetic purposes was good to high in
80% of patients.11 In our study, more than 80% of the patients were
6 of 7
satisfied with the result. To note that the satisfaction rate usually is
decreased in older population and in secondary rhinoplasty when
25
compared to primary procedures.
Nose lipofilling has a relatively low complication rate when com-
pared to using synthetic implants.3 Ecchymosis was reported in
combined lipofilling and surgical rhinoplasty, and only mild swelling
occurred during lipofilling solely.6 This was consistent with our study,
where patients suffered from only a mild edema and ecchymosis that
resolved in the coming week of fat filling. On the other side, surgical
rhinoplasty presented other complications such as skin necrosis and
infection.26 To note that a secondary surgical rhinoplasty can aggra-
vate the shape of nose and make it more difficult to correct.27 Here
comes the role of fat filling which can as previously mentioned
improve and remodel the scar to ameliorate the outcome with low
complication rates.
In our series, we did not have vascular complications associated
with nasal fat filling. Injection was done using a small diameter 1 mm
Coleman cannula, in a retrograde manner, using low injection pres-
sure, and in the supra periosteal plane. But fat grafting technique
should not be considered a risk free procedure since embolization is a
possible complication after glabellar lipofilling and can cause middle
cerebral artery embolism.28 A good knowledge of nasal vascular anat-
omy is thus required to prevent these side effects.6
Lipofillingis a relatively simple alternative and low-cost procedure
compared to surgical rhinoplasty.17 It's superior to other fillers due to its
longer effects and less need for repeated sessions in the long term.6 It
has also better tolerance and rare rejection risk.6 So fat is an autologous,
safe, nontoxic, non-immunogenic, non-teratogenic, non-carcinogenic,
easy to harvest, long lasting material that might be considered as a filler
of reference for facial rejuvenation and nasal surgery.
5 | C O N CL U S I O N
Fat grafting is widely used in numerous applications in maxillo-facial and
plastic surgery. Nonetheless, it is rarely used in nasal procedures. This
study paves the way to standardize lipofilling as an important tool to ben-
efit from in the correction of postrhinoplasty deformities and to improve
outcome before a secondary surgery. Given its rejuvenation properties
and its volumetric effect, it can be applied as a treatment for nasal
inherited deformities as well as for cosmetic purposes. Thus nasal fat fill-
ing can increase patients' satisfaction and decrease side effects. Further
large multicentric randomized controlled studies are needed to assess the
use of nose lipofilling in various indications and to assess its advantages
and limitations when compared to revision surgical rhinoplasty.
CONF LICT OF IN TE RE ST
The authors declare no potential conflict of interest.
DATA AVAI LAB ILITY S TATEMENT
The data that support the findings of this study are available on
request from the corresponding author. The data are not publicly
available due to privacy or ethical restrictions.
CHALLITA ET AL.
OR CID
Raymond Challita https://orcid.org/0000-0003-4521-0899
RE FE RE NCE S
1. Miyahara LK, Stefanini R, Suguri VM, Wawginiak GH, Balsalobre RA,
Haddad FLM. Evaluation of sleep quality and risk of obstructive sleep
apnea in patients referred for aesthetic rhinoplasty. Sleep Sci. 2019;12
(3):126-131.
2. Cosmetic plastic surgery statistics [Internet]. 2019. https://www.
plasticsurgery.org/documents/News/Statistics/2019/plastic-surgery-
statistics-full-report-2019.pdf
3. Simonacci F, Bertozzi N, Grieco MP, Grignaffini E, Raposio E. Proce-
dure, applications, and outcomes of autologous fat grafting. Ann Med
Surg (Lond). 2017;20:49-60.
4. Benateau H, Rocha CS, Rocha Fde S, Veyssiere A. Treatment of the
nasal abnormalities of Hallermann-Streiff syndrome by lipofilling. Int J
Oral Maxillofac Surg. 2015;44(10):1246-1249.
5. Kontis TC, Rivkin A. The history of injectable facial fillers. Facial Plast
Surg. 2009;25(2):67-72.
6. Monreal J. Fat grafting to the nose: personal experience with
36 patients. Aesthetic Plast Surg. 2011;35(5):916-922.
7. Mehta U, Fridirici Z. Advanced techniques in nonsurgical rhinoplasty.
Facial Plast Surg Clin North Am. 2019;27(3):355-365.
8. Jasin ME. Nonsurgical rhinoplasty using dermal fillers. Facial Plast Surg
Clin North Am. 2013;21(2):241-252.
9. Mojallal A, Lequeux C, Shipkov C, et al. Improvement of skin quality
after fat grafting: clinical observation and an animal study. Plast
Reconstr Surg. 2009;124(3):765-774.
10. Derby BM, Dai H, Reichensperger J, et al. Adipose-derived stem cell
to epithelial stem cell transdifferentiation: a mechanism to potentially
improve understanding of fat grafting's impact on skin rejuvenation.
Aesthet Surg J. 2014;34(1):142-153.
11. Baptista C, Nguyen PSA, Desouches C, Magalon G, Bardot J,
Casanova D. Correction of sequelae of rhinoplasty by lipofilling.
J Plast Reconstr Aesthet Surg. 2013;66(6):805-811.
12. Khan N, Rashid M, Khan I, et al. Satisfaction in patients after rhino-
plasty using the rhinoplasty outcome evaluation questionnaire.
Cureus. 2019;11(7):e5283.
13. Requena L, Requena C, Christensen L, Zimmermann US, Kutzner H,
Cerroni L. Adverse reactions to injectable soft tissue fillers. J Am Acad
Dermatol. 2011;64(1):1-34.
14. Williams LC, Kidwai SM, Mehta K, Kamel G, Tepper OM, Rosenberg JD.
Nonsurgical rhinoplasty: a systematic review of technique, outcomes,
and complications. Plast Reconstr Surg. 2020;146(1):41-51.
15. Khouri RK, Smit JM, Cardoso E, et al. Percutaneous aponeurotomy
and lipofilling: a regenerative alternative to flap reconstruction? Plast
Reconstr Surg. 2013;132(5):1280-1290.
16. Kao WP, Lin YN, Lin TY, et al. Microautologous fat transplantation for
primary augmentation rhinoplasty: long-term monitoring of 198 Asian
patients. Aesthet Surg J. 2016;36(6):648-656.
17. Gornitsky J, Viezel-Mathieu A, Alnaif N, Azzi AJ, Gilardino MS. A sys-
tematic review of the effectiveness and complications of fat grafting
in the facial region. JPRAS Open. 2018;19:87-97.
18. van Dongen JA, van Boxtel J, Harmsen MC, Stevens HP. The devel-
opment of facial Lipofilling from a historical point of view. Facial Plast
Surg. 2019;35(4):358-367.
19. Lv Q, Li X, Qi Y, Gu Y, Liu Z, Ma GE. Volume retention after facial fat
grafting and relevant factors: a systematic review and meta-analysis.
Aesthetic Plast Surg. 2020;45:506-520.
20. Lin S, Hsiao YC, Huang JJ, et al. Minimal invasive rhinoplasty: fat
injection for nasal dorsum contouring. Ann Plast Surg. 2017;78(3
Suppl 2):S117-S23.
21. Erdim M, Tezel E, Numanoglu A, Sav A. The effects of the size of lipo-
suction cannula on adipocyte survival and the optimum temperature
CHALLITA ET AL. 7 of 7

for fat graft storage: an experimental study. J Plast Reconstr Aesthet
Surg. 2009;62(9):1210-1214.
22. Kakagia D, Pallua N. Autologous fat grafting: in search of the optimal
technique. Surg Innov. 2014;21(3):327-336.
23. Bagal AA, Adamson PA. Revision rhinoplasty. Facial Plast Surg. 2002;
18(4):233-244.
24. Xu J, Jiang B, Shen Y. Effectiveness of autologous fat grafting in scar-
ing after augmentation rhinoplasty. J Craniofac Surg. 2019;30:1.
25. Abbas OL. Revision rhinoplasty: measurement of patient-reported
outcomes and analysis of predictive factors. Springerplus. 2016;5(1):
1472.
26. Challita R, Shouman M, Ghanime G. Rhinoplasty and external nasal
splinting: is it really a must? Plast Reconstr Surg Glob Open. 2019;7(8):
e2374.
27. Valente DS, Steffen N, Valente S. Abstract: dermal fillers in secondary
rhinoplasty. Plast Reconstr Surg Glob Open. 2018;6(8S):242-243.
28. Egido JA, Arroyo R, Marcos A, Jimenez-Alfaro I. Middle cerebral
artery embolism and unilateral visual loss after autologous fat injec-
tion into the glabellar area. Stroke. 1993;24(4):615-616.
How to cite this article: Challita R, Sleiman Z, Bazzi N,
Ghanime G. Our experience with lipofilling in secondary
rhinoplasty, into a new era. Dermatologic Therapy. 2021;
e14989. https://doi.org/10.1111/dth.14989