Commentary on: The Risk of Skin Necrosis Following Hyaluronic Acid Filler Injection in Patients With a History of Cosmetic Rhinoplasty

Nonsurgical Rhinoplasty Using Injectable Fillers: A Safety Review of 2488 Procedures

Background: Injectable fillers are used worldwide to improve the appearance of the nose by nonsurgical methods. The procedure is not without risks, as blindness and skin necrosis have been reported as a consequence of filler injections in the nose. Objective: To determine an overall adverse event (AE) rate for the nonsurgical rhinoplasty (NSR) procedure and to assess whether previous surgical rhinoplasty increases the odds of an AE. Methods: A retrospective chart review of 2275 patients and 2488 NSR procedures for a 10-year period from a single physician injector was conducted. Results: The overall procedural AE rate was 7.6%, with five cases (0.20%) considered serious (ischemia and necrosis). Previous surgical rhinoplasty patients had a greater AE rate (10.8%) than those patients without previous surgery (7.4%), with a significant odds ratio of 1.51 (95% confidence interval: 1.03-2.18); p = 0.032. Injecting the tip and sidewall of the nose had the highest AE rates for both categories of patients. Conclusions: NSR is a relatively safe procedure with the majority of AEs common injection site reactions. Patients with previous surgical rhinoplasty demonstrated significantly increased odds of an AE potentially due to surgical changes in anatomy.