The Use of Hyaluronic Acid in Non-surgical Rhinoplasty: A Systematic Review of Complications, Clinical, and Patient-Reported Outcomes

Mataro I, Orlandino G, La Padula S.

PubMed 37783865 Publisher (DOI)Free full text (PMC)

What this paper says

A letter responding to the Mortada et al. systematic review of hyaluronic acid filler rhinoplasty, arguing that the review should have accounted for the physical properties (viscosity, elasticity, cohesiveness) of the specific fillers used.

Overview

This is a commentary with no data. Mataro, Orlandino and La Padula note that the reviewed studies used different hyaluronic acid products without standardisation, and that filler rheology, how a gel flows and deforms under stress, determines where it can safely be placed in the nose and how it behaves. They ask that future analyses link filler properties to outcomes and complications.

Sections of note

The original review is described as meticulous but its included studies lacked standardisation of the active substance.
Three rheological properties are highlighted: viscosity, elasticity and cohesiveness.
The letter argues these properties are pivotal to selecting a filler for nasal use.
Level of Evidence V.

What it means for a patient

Not all hyaluronic acid fillers are the same; firmer, more cohesive gels behave differently in the nose.
When assessing safety claims, ask which product was used and whether it is suited to the nose.

Why this paper matters

It flags a methodological gap in the filler-rhinoplasty literature: product heterogeneity. Limits: opinion only.

Terms

Rheology: the study of how materials flow and deform.
Viscosity: resistance to flow.
Elasticity (G prime): a gel's ability to hold shape under pressure.
Cohesiveness: how well a gel holds together rather than spreading.
Letter to the editor: a short published response to an article.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

We reviewed the article titled "The Use of Hyaluronic Acid in Non-surgical Rhinoplasty: A Systematic Review of Complications, Clinical, and Patient-Reported Outcomes" authored by Mortada et al. in Aesthetic Plastic Surgery with considerable interest. This study presents a meticulous systematic review of research examining clinical and patient-reported results in hyaluronic acid (HA) non-surgical rhinoplasty. However, we hold specific reservations about the methodologies employed in the studies encompassed within their analysis. Precise comprehension of the properties of the utilized active substance is essential for any treatment, with standardization being a key factor. Understanding the essential characteristics of the administered HAs is pivotal to establish potential connections between these attributes, outcomes, and complications. Of particular importance in the clinical application of tissue volumization via fillers is rheology, the study of material flow and deformation under stress. Gaining insight into HA's rheological properties is imperative when selecting an appropriate dermal filler for nasal applications. Three pivotal HA properties are viscosity, elasticity, and cohesiveness. While appreciating the authors' contributions, further analysis should account for these factors in their investigation.Level of Evidence V 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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