Management of Patients Seeking Surgical Rhinoplasty with Previous Nasal Injections of Hyaluronic Acid

Ramos HHA, Freire L, Cavallieri F, Frota AE, Ragazzo R, Jurado JRP.

PubMed 33616714 Publisher (DOI)Free full text (PMC)

What this paper says

An illustrative case article proposing three ways to handle a patient who wants surgical rhinoplasty after previous hyaluronic acid filler in the nose: wait for the filler to absorb, dissolve it first, or operate without dissolving it.

Overview

Patients increasingly choose minimally invasive procedures with little downtime, but the authors state these are not usually long lasting and give limited results for both appearance and breathing. As a result more patients present for surgical rhinoplasty having already had filler injected into the nose. The article aims to help surgeons identify such patients and plan the operation.

Sections of note

Case based article; the journal assigns level of evidence IV.
The abstract reports no patient numbers, no outcomes, no complication rates and no follow up.
Cases are presented to illustrate the approach.
Three management options are proposed: wait for the hyaluronic acid to be reabsorbed naturally, apply hyaluronidase before surgery, or proceed to rhinoplasty with no prior hyaluronidase.
The authors state the surgeon must be aware of how filler behaves over time and manage each case accordingly.

What it means for a patient

Previous nasal filler is relevant history before rhinoplasty and should be disclosed.
Filler can distort the tissue planes a surgeon works through, which is why timing and dissolving are considered.
No data is given on which of the three approaches produces better results.
The article offers a decision framework rather than evidence.

Why this paper matters

Filler rhinoplasty has been performed in large numbers for over a decade, so a growing share of surgical candidates have residual or previous filler. This article is among the first to address that sequence directly. Which management option is best has not been compared.

Terms

Hyaluronic acid filler: an injectable gel used to add volume, which can be dissolved.
Hyaluronidase: an enzyme injected to dissolve hyaluronic acid filler.
Reabsorption: the body gradually breaking down and removing injected filler.
Minimally invasive: a procedure done without surgical incisions.
Level of evidence IV: a case series or case report, a weak evidence category.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Background: Patients are looking for procedures which are minimally invasive and consequently incur minimal downtime. However, these procedures are not usually long lasting and have limited outcomes both esthetically and functionally. For these reasons, the number of patients seeking surgical rhinoplasty and who have previous nasally injected hyaluronic acid is increasing.

Methods: The aim of this article is to provide the surgeon with information for both the identification and surgical approach for those patients who seek nasal cosmetic surgery, and who have previously been treated with nasal injections of hyaluronic acid filler.

Results: We present cases that illustrate the use of this approach and suggest three possible patient management.

Conclusions: There are three possible approaches: wait HA to be naturally reabsorbed; apply hyaluronidase before the surgery or proceed to rhinoplasty with no prior application of hyaluronidase. The physician must be aware of this progression and know how to manage each case to optimize the surgical outcome.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).