Serious Vascular Complications after Nonsurgical Rhinoplasty: A Case Report

Overview

Demand for dermal filler injections has risen worldwide, and hyaluronic acid fillers generally have a good safety record. Serious complications involving blood vessels have nonetheless been reported. The authors present a case of skin necrosis after non-surgical rhinoplasty and argue for familiarity with the vascular anatomy and with how these complications are graded.

Sections of note

• Case report of a single patient.
• The procedure was non-surgical rhinoplasty using hyaluronic acid filler.
• Skin necrosis followed the injection.
• Various rescue treatments were attempted.
• The outcome was unsightly superficial scarring.
• The authors state that suspected vascular complications need early management under close monitoring, and that the case arose from illegal practice, which they say calls for stricter regulation and enforcement.

What it means for a patient

• Filler injected into or compressing an artery in the nose can cut off blood supply and kill the overlying skin.
• Treatment exists but must start early, and even then permanent scarring can result, as it did here.
• Hyaluronic acid can be dissolved with an enzyme, which is one reason it is preferred over permanent fillers in this area.
• The report names unlicensed practice as the setting, which is a point about who performs the injection rather than about the product itself.
• A single case cannot indicate how often this occurs.

Why this paper matters

Non-surgical rhinoplasty is marketed as low risk, and the nose is among the highest-risk facial areas for filler because of how its arteries run. Documented cases of skin loss are the counterweight to that marketing. What case reports cannot supply is a complication rate or evidence on which rescue treatments work.

Terms

• Non-surgical rhinoplasty: reshaping the nose with injectable filler rather than surgery.
• Dermal filler: an injectable gel used to add volume beneath the skin.
• Hyaluronic acid: a gel filler the body breaks down, which can be dissolved with an enzyme.
• Vascular complication: harm caused by blockage of or damage to a blood vessel.
• Necrosis: death of tissue from loss of blood supply.
• Superficial scar: a scar affecting the surface layers of the skin.