Injection Rhinoplasty with Hyaluronic Acid and Calcium Hydroxyapatite: A Retrospective Survey Investigating Outcome and Complication Rates

Overview

Injecting filler into the nose can smooth small irregularities without an operation, and the effect wears off rather than being permanent. The author reviewed three years of such treatments using two degradable fillers, comparing before and after images and surveying patients at two time points.

Sections of note

• 46 patients treated across 88 areas over three years. Calcium hydroxyapatite in 26 patients, hyaluronic acid in 20.
• Satisfaction was measured with a 5-point questionnaire at 3 weeks and at 9 months or later.
• 85 percent were satisfied at 3 weeks. 87 percent were very or completely satisfied at 9 months or later, regardless of which filler was used.
• Effect lasted between 6 and 30 months, mean 13.5 months.
• The author attributes positive ratings mainly to accurate prediction beforehand of what the treatment could achieve.
• One moderate and two severe complications occurred, all after calcium hydroxyapatite. Two resolved fully and one patient was lost to follow-up. The practice then switched to hyaluronic acid only.

What it means for a patient

• Filler can correct minor bumps and dips in the nose without surgery, but the correction fades and needs repeating, on average after just over a year.
• Satisfaction was high and did not depend on which filler was used, so the safer material is the reasonable default.
• Three of 46 patients had complications, all with calcium hydroxyapatite, and the practice stopped using it as a result. Hyaluronic acid can also be dissolved if there is a problem.
• Retrospective review from one practice, small numbers, no comparison with surgery, and the severity scale used is not defined in the abstract.

Why this paper matters

Non-surgical rhinoplasty grew rapidly in this period with limited published safety data, and filler complications in the nose can be serious because of its blood supply. Reporting that all complications came from one material, and changing practice accordingly, is directly useful. Numbers remain too small to establish a complication rate.

Terms

• Injection rhinoplasty: reshaping the nose with injectable filler rather than surgery.
• Hyaluronic acid filler: a gel filler that the body breaks down and that can be dissolved with an enzyme.
• Calcium hydroxyapatite: a thicker, longer-lasting filler made of mineral particles in gel, not reversible.
• Biodegradable: broken down and absorbed by the body over time.