Complications of Nonsurgical Rhinoplasty with Hyaluronic Acid Injections: A Narrative Review

Caranti A, Thomas R, Facchini F, Campisi R, Bianchini C, Pelucchi S, Ciorba A, Iannella G, Maniaci A, Michel J, Vicini C.

PubMed 39747417 Publisher (DOI)Free full text (PMC)

What this paper says

A review of 80 articles cataloguing the complications of nasal filler, from asymmetry and swelling to vascular occlusion causing skin death or blindness, concluding that severe events are uncommon but require immediate management.

Overview

The Italian authors searched PubMed and Embase for January 1990 to September 2023, identified 180 articles and included 80, following PRISMA. They organised complications by onset and severity and summarised prevention and treatment.

Sections of note

Common early problems: asymmetry, injection-site reactions, hypersensitivity.
Severe: vascular occlusion leading to tissue ischaemia, necrosis or blindness.
Also documented: infection, Tyndall effect, nodules, granulomas, scarring, biofilms.
Incidence of severe complications described as relatively low.
Level of Evidence IV.

What it means for a patient

Most filler problems are minor and temporary; the rare serious ones involve a blocked artery and can be permanent.
Prevention depends on the injector's anatomical knowledge and technique; ask what protocol is used and what reversal agent is on hand.
Late problems such as nodules and bluish discolouration can appear months later.

Why this paper matters

It is a current catalogue of everything that can go wrong with the most common non-surgical nose procedure. Limits: narrative rather than pooled, no incidence figures given in the abstract.

Terms

Vascular occlusion: filler blocking an artery, cutting off blood supply.
Necrosis: death of skin or tissue from lost blood supply.
Tyndall effect: a bluish tint when filler sits too close to the skin surface.
Granuloma: a lump of inflammatory tissue forming around foreign material.
Biofilm: a community of bacteria on the filler that resists antibiotics.

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

Abstract

Background: The increasing popularity of cosmetic procedures has led to a rise in both surgical and nonsurgical interventions. Rhinoplasty, particularly nonsurgical rhinoplasty using injectable fillers such as hyaluronic acid (HA), has become highly sought after due to its minimally invasive nature. Despite its benefits, complications can occur, ranging from minor to severe.

Methods: This narrative review adheres to PRISMA guidelines and evaluates the complications associated with injectable rhinofillers. A comprehensive search was conducted in PubMed and Embase databases for articles published between January 1, 1990, and September 30, 2023, using specific keywords related to nonsurgical rhinoplasty and its complications. A total of 180 articles were identified, with 80 included in the final review.

Results: Complications from injectable rhinofillers vary widely. Common early-onset issues include asymmetry, injection site reactions, and hypersensitivity. Severe complications like vascular occlusion can lead to tissue ischemia, necrosis, or even blindness. Infection, Tyndall effect, nodules, granulomas, scarring, and biofilms are also documented. The incidence of severe complications is relatively low but requires immediate and effective management to prevent long-term consequences.

Conclusions: Nonsurgical rhinoplasty using fillers, particularly HA, is generally safe with a low risk of severe complications. Awareness and prompt management of potential complications are crucial for practitioners. Preventative measures, precise techniques, and thorough anatomical knowledge can mitigate risks, ensuring better patient outcomes.

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 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).