An Italian Online Survey Regarding the Use of Hyaluronidase in Previously Hyaluronic Acid-Injected Noses Looking for Surgical Rhinoplasty

Abstract

Background Nonsurgical nasal reshaping (nSNR) with hyaluronic acid (HA) filler is a well-established procedure performed to ameliorate nasal appearance and considered a valid alternative to surgical rhinoplasty in selected patients. Objective The aim of our study is to evaluate the decision-making process and management of patients undergoing rhinoplasty, with previous HA filler injection, and evaluate if consensus could be achieved to recommend guidelines. Methods Between April and May 2021 an on-line survey was sent to 402 Italian surgeons of different specialties. The survey collected information regarding types of treatment of patients who have previously undergone nSNR, who should undergo surgical rhinoplasty. For those surgeons using hyaluronidase an additional information was collected. Results In a range of time of two months (April-May 2021) a total of 72 surgeons replied and completed the survey: out of the 402 questionnaires sent, the response rate was of approximately 18%. The majority of respondent (61,5%) replied to inject hyaluronidase (HYAL) in patients who had to undergo a rhinoplasty but reported previous nSNR. Of the surgeons who use HYAL, 70% performed rhinophasty after a waiting time of 3 to 4 weeks. Conclusions Either direct surgical approach or hyaluronidase injection first seems to be a viable options. The use of HYAL before surgery is the choice with the broadest consensus in our survey. However a larger case-control study with long follow-ups is necessary to understand if in patient seeking surgical rhinoplasty who already received nSNR, the injection of hyaluronidase prior to surgery is mandatory, recommended or not.

Postoperative Fillers Reduce Revision Rates in Rhinoplasty

“…It is thought that fillers last in the nose longer than elsewhere with some reports of fillers lasting in the nose for 3 years. 1 , 8 , 12 The reality is, though, that we do not know how long fillers will last in the nose, especially following surgery.…”

Desafios da rinoplastia cirúrgica em nariz previamente preenchido com ácido hialurônico

“…Os preenchedores de AH são reabsorvíveis; porém, quando injetados na região nasal, parecem ter resultados imprevisíveis e, por isso, não é possível prever com precisão quando o AH será totalmente reabsorvido antes da realização da rinoplastia. Portanto, dadas as inúmeras variáveis, o exame clínico e ultrassonográfico cuidadoso na avaliação pré-cirúrgica é de considerável importância (STAGLIANÒ S, et al, 2022). O exame de ultrassom, ou o exame clínico de transluminescência (efeito Tyndall) permitirá avaliar a natureza do preenchedor utilizado e a possível presença de volume residual, antes de estabelecer um plano de dissecção cirúrgica correta (RAMOS HHA, et al, 2021).…”