Consensus Recommendations on the Use of Hyaluronic Acid–Based Fillers for Nonsurgical Nasal Augmentation in Asian Patients

Abstract

Background: Nonsurgical nasal augmentation using dermal fillers such as hyaluronic acid is increasing in popularity because of its less invasive nature and shorter downtime compared with traditional surgery. However, the complexity of the nasal vasculature makes it a high-risk procedure without proper training. Appropriate patient and product selection and safer standardized injection techniques are warranted to minimize complications and to achieve reproducible aesthetic results. In this article, recommendations for nonsurgical nasal augmentation using hyaluronic acid fillers are outlined, with focus on the dorsum, tip, and columella. Methods: A consensus meeting was conducted to develop recommendations on nonsurgical nasal augmentation in Asian patients using hyaluronic acidbased fillers. Literature review was performed using PubMed and Google Scholar. Relevant studies were included to formulate recommendations. Consensus statements were graded using the criteria outlined by the Grading of Recommendations Assessment, Development and Evaluation Working Group. Results: Nonsurgical nasal augmentation is an advanced procedure that warrants in-depth knowledge of the nasal anatomy. The panel recommends thorough preinjection assessment and counseling to fully align the patient's expectations with aesthetic goals. Injections must be deep and at the level of the periosteum or perichondrium to minimize risk of intravascular injection. Aliquots of hyaluronic acid must be introduced using slow, low-pressure, and low-volume injections. Optimal aesthetic effect is achieved with hyaluronic acid dermal fillers that are highly elastic, cohesive, and with good adaptability to their environment. Conclusions: Hyaluronic acid injections are safe and effective in nonsurgical nasal augmentation. In-depth knowledge of vascular anatomy and proper injection techniques using suitable products are necessary to achieve aesthetic goals safely.

Ultrasound assessment of the nose vasculature: A review of the common method of non‐surgical filler‐based rhinoplasty

“…11,13,15,17,19,20 HA fillers are the most commonly used injectables for NSR procedure. 9,13,15,17,19,20 The growing popularity of NSR among patients and physicians might be attributed to the lower costs, short recovery period, reversibility (if done by HA fillers), prompt obvious results, and perceived safety as a semi-invasive procedure compared to surgery. 9,[13][14][15][16][17]19,20 Studies show that NSR is generally safe and the rate of reported side effects is low.…”

“…13,14 Based on the available scientific literature about the anatomic distribution of the mentioned vessels and their branches, injecting deep (supraperichondrial or supraperiosteal) at the midline of the nose is recommended to minimize vascular complications. 8,9,11,[13][14][15][16][17][18] To challenge the recommended layer of injection in primary NSR (deep at midline), we studied the vascular pattern of the nose of a group of our aesthetic clinic clients using a linear portable 14 MHz handheld ultrasound transducer with Doppler properties (Silarious L14PS HD Portable Doppler Ultrasound Scanner). All study population were Iranian women selected by convenience sampling from January to March 2023.…”

“…[8][9][10][11][12] In addition, there is not a consensus or guideline for the method of conducting NSR, and this gap can confuse or even mislead practitioners as they may obtain recommendations from various sources, some are without adequate scientific basis or evidence. 11,12,[14][15][16][17] In this article, based on an ultrasound study of the nasal vascular anatomy of a group of people, we declare the importance of considering personal anatomic variations during NSR, bring the commonly conducted technique of NSR into question, and provide convincing evidence for the use of ultrasound-assisted tailored aesthetic treatment of the nose to minimize complications. We believe that this study can influence the attitudes of aesthetic practitioners toward using ultrasound in their daily practice.…”

Prospective bacterial and fungal sources of hyaluronic acid: A review

“…The unique viscosity and high rheological affinity for natural fluids has rendered a high interest in cross-linked HA in a wide range of biomedical applications, such as destruction preventer and restoration initiator of cartilage during osteoarthritis [56] , [57] , eye drops for dry eye syndrome [58] , [59] , and dermal fillers [60] , [61] .…”

Post‐rhinoplasty complications with previous hyaluronic acid injection history: Cerebral infarction and vision loss

“…Hyaluronic acid (HA) has strong hydrophilic properties and is a commonly used nonsurgical filler 1 . HA injections are considered safe but, in rare cases, may lead to complications of vascular embolism, cerebral infarction, and visual impairment 2 . These complications usually occur immediately after the onset of vascular embolism.…”