LAUSR

I appreciate the comments and suggestions on my modest article. I believe that complications in the future can be reduced, thanks to these comments. As filler rhinoplasty may result in blindness, the nasal region should be carefully monitored for a disastrous complication, special attention, and care. I believe that the comments and study 1 would add to my article. Injection in the subcutaneous layer at the midline of the nose may not be safe 2 : I agree with this widely accepted opinion. However, the nasal artery can be located in any nasal layer. Therefore, there is no safety zone in the nasal region. 3 In addition, I agree with the opinion that Clinicians should manipulate the cannula as little as possible. 2 Only performing the manipulation as slowly and cautiously as possible will ensure safety. Several controversies exist regarding the safety of a cannula depending on its diameter. I regard, as reasonable and appropriate, the opinion that small-bore cannulas are more dangerous. I agree with the opinion that small-bore cannulas could perforate a thick artery more easily. I think the article cited, which comparatively investigated the cannula diameter and that of arteries, is a useful study. Blindness, a disastrous complication, occurs when filler particles obstruct the central retinal artery by reverse flow in the internal carotid artery via the dorsal nasal artery, which results from injection pressure being higher than the arterial pressure. In case of arterial perforation by a cannula, the filler flows out slowly through a small-bore cannula, while a large bore cannula could result in more leakage of material more rapidly. Further studies on the safety of cannula diameters are needed. 4 , 5 I compared two fillers (Teosyal R © PureSense Ultra Deep and PureSense Ultimate, Teoxane Lab, Switzerland) focusing on their elasticity levels. I have not performed experiments to obtain rheologic data. Rheologic experiments should be considered and resulting data could potentially be used as a more standard evaluation index.