Complications and management after a nonsurgical rhinoplasty: a literature review

Abstract

Nonsurgical rhinoplasty with injectable fillers has become an increasingly popular option in recent years. Their rise in popularity has been driven by a number of factors, including their minimally invasive nature and the cost lower than surgical option. Physicians should keep in mind that there are many possible complications, especially in the hands of a novice injector. Fortunately, most complications are minor and transient in nature, although the patient may consider them aesthetically displeasing and unacceptable. Major complications are rare; however, an inadequate treatment can produce transient to permanent damage for the patient. A review of the medical literature from 2002 was performed to gather information on main complications after nasal injections using the databases of the National Library of Medicine, Ovid MEDLINE, and Cochrane Library. Understanding the basic anatomical knowledge of the midface, especially the vascular system, is fundamental to prevent the appearance of complications. However, recognize immediately the symptoms and know the correct treatment in case of complications is the only way to minimize permanent bad outcome.

Seguridad en la aplicación de rellenos faciales. Medicina basada en evidencia

“…Asimismo, contribuyen al mismo fin el conocimiento profundo de la anatomía y de una historia clínica completa que incluya antecedentes de contraindicaciones relativas o absolutas y los cambios postquirúrgicos, por ejemplo, rinoplastia, donde la gran mayoría de los casos presentan un cambio en la vascularización y fibrosis de ciertas áreas. 4,8,15,30,31 La arteria oftálmica se asocia significativamente con ceguera irreversible. En este sentido, la ceguera unilateral es el evento adverso vascular más frecuente; la grasa autóloga tiende a causar más casos de daño vascular permanente.…”

Use of injectables in rhinoplasty retouching: Towards an evolution of surgical strategy? Literature review

“…On the other hand, severe complications are rare with a mean rate of 0.4% (range 0-4) but they are most of the time critical. These are granulomas and vascular embolism causing skin necrosis or visual impairment [40,41]. Anatomy of the nose and physiopathology of the complications are important to understand for managing fillers complications.…”

“…Between the skin and the bony-cartilaginous framework there are 4 layers: superficial fatty layer, fibromuscular layer or superficial muscular aponeurotic system (SMAS), deep fatty layer, and periosteum-perichondrium [29,40].…”

“…Topical nitropaste under occlusion, oral acetylsalicylic acid (aspirin), warm compresses, and vigorous massage are also useful. Secondary lines of treatment may involve intra-arterial hyaluronidase, hyperbaric oxygen therapy, and ancillary vasodilating agents (prostaglandin E1) [40,[56][57][58][59]. At all, reported management strategies vary greatly from surgeons and there is no treatment that is consistently successful [41].…”

Complications in Facial Esthetic Surgery

“…58 Certain areas of the face, such as the glabella, alar base, nose, and temple, are associated with risks of vascular complications. 58,59 Esthetic providers that perform HA filler injections should keep a tool kit on hand for managing complications, should they arise. 58 Aside from vascular complications, allergic reactions, infection, inappropriate placement, and inflammatory and noninflammatory nodules can be encountered.…”