Complications Secondary to Nonsurgical Rhinoplasty: A Systematic Review and Meta-analysis

Outcome Evaluation of Reconstructive Septorhinoplasty in Patients with a History of Nasal Skin Necrosis

Background: Nasal skin necrosis represents a severe rhinoplasty complication, potentially leading to nasal deformity and psychological distress. Objectives: To assess the safety, nasal function enhancement, and esthetic satisfaction in individuals with a history of nasal skin necrosis following reconstructive septorhinoplasty using patient-reported outcome measures. Methods: The case series included patients who underwent reconstructive septorhinoplasty 1 year after experiencing skin necrosis. Skeletal reconstruction was performed with an open approach using various autografts and techniques. The data collected encompassed demographics, medical history, operative reports, and postoperative events. The Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) was administered preoperatively and 1 year postoperatively. Results: Most patients were female (35/38, 92%), with median age of 33.5 years (17-57) and 2 prior rhinoplasties (1-5) by 1 surgeon (1-2). The follow-up median was 23.78 months (11.83-54.23). Necrosis predominantly affected the nasal tip and soft tissue triangles. Septorhinoplasty utilized 11 V-shaped columellar base and 27 mid-columella incisions, lasting on average 274 min (175-405). Septal grafts were adequate for reconstruction in only three cases. Autografts for reconstruction encompassed auricular cartilage (31), rib cartilage (22), temporal fascia (14), and rectus fascia (6). SCHNOS scores improved significantly, with the obstruction domain decreasing from a preoperative mean of 75.92 (±22.83) to 34.08 (±27.87) and the cosmesis domain from 85.43 (±19.06) to 39.73 (±23.77). No postoperative severe vascular complication occurred. More previous surgeries linked to decreased patient satisfaction. Conclusion: Reconstructive septorhinoplasty can be successful in restoring relatively normal nasal contour following prior soft tissue necrosis, with limited risk for complications.

Nonsurgical Rhinoplasty in Patients of African Descent: A Retrospective Review

BACKGROUND

There is a paucity of research on nonsurgical rhinoplasty in the population of African descent. In this group, underlying anatomy and aesthetic ideals vary, necessitating differences in the consultation process and in treatment. The authors present a case series from a single clinician's practice performing nonsurgical rhinoplasty on patients of African descent.

METHODS

A retrospective chart review was completed on eligible patients who underwent nonsurgical rhinoplasty treatment with hyaluronic acid filler injections performed by the first author (A.H.) from March of 2018 to February of 2021. Demographic variables, indications for treatment, patient-reported outcomes, and adverse events were reviewed. The authors also share the first author's technique for nonsurgical rhinoplasty in this patient cohort.

RESULTS

A total of 487 patients of African descent or mixed race including African descent were included in this study. The most common indications for treatment were lack of bridge definition (63.9%), excessive alar width (61.6%), and a bulbous tip (61.6%). Median filler volume was 0.6 mL (range, 0.3 to 2.1 mL) at the initial treatment visit. There were no reported cases of infection, vascular occlusion, or necrosis.

CONCLUSIONS

This study is the first to illustrate the effectiveness and safety profile of nonsurgical rhinoplasty in a population of African descent. Anatomical variations and the desire for racially congruent results must be acknowledged to ensure satisfactory outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

The Use of Cross-Linked Hyaluronic Acid in Non-surgical Rhinoplasty Using Italian Technique

INTRODUCTION

Projection and upper rotation to the tip is fundamental in the nasal rejuvenation, as a matter of fact the tip is the most important and has strongly effects on the improve appearance and quality of life. The aim of the present study was to evaluate reshaping the tip of the nose by cross-linked hyaluronic acid using Italian technique.

METHODS

In a period between November 2019 and 2023, a total of one hundred and forty healthy, 95 females and 45 man patients, were performed with a mean age 44±5 (age range: 31-52 years old) affected by tip of congenital (22) or ageing nose hypotonia (118), and reduced volume that need of an elevation of the nose tip. The anatomic markers have been considered for the anthropometric measurements after the filler rhinoplasty. Two infiltrations were performed, one in the infiltration into the antero-caudal access over the columella produce upward rotation of the tip of the nose and second infiltration into the antero-superior access produce the projection of the tip of the nose. Medical device used in the study was Neofound STRUCT LIDO (LOVE COSMEDICAL srls-Via Toniolo 9, 57022 Castagneto Carducci, ITALY) containing sodium hyaluronate/hyaluronic acid high molecular weight (1.500

RESULTS

The effect on the upward rotation of the tip nose was evaluated using Global Aesthetic Improvement Scale and morphometric evaluation. All the subjects showed at least 2-3 grade improvement in GAIS score after HA filler injection. The analysis of patient satisfaction after the last follow-up visits clearly demonstrated good results. A significant morphometric difference was detected comparing the T0 and T90 (p<0,0001), while no difference was present comparing T90 and T180 means (p=0.11). The outcome of the present clinical study gives greater projection and upper rotation to the tip with great gratification of the patients and the surgeon. An augmentation of the tip nose with hyaluronic acid filler produces a rejuvenation of the nose area resulted in a more youthful appearance. No adverse event was observed. In 35 patients, additional HA infiltration had to be performed after 2 weeks.

CONCLUSION

In conclusion, the Italian technique descripted in the present paper is safe, simply, and efficacious for rejuvenation of the nose, with elevated levels of patient satisfaction.

LEVEL OF EVIDENCE II

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 .

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Key Words

• Aesthetic
• Filler
• Hyaluronic acid
• Non-surgical rhinoplasty
• Nose reshaping
• Rhinofiller
• Rhinoplasty

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Affiliation(s)

Antonio Scarano Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, Via Dei Vestini 31, 66100, Chieti, Italy.
Andrea Sbarbati Department of Neurosciences, School of Medicine, Biomedicine and Movement Sciences, Anatomy and Histology Section, University of Verona, Verona, Italy
Domenico Amuso Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, Chieti, Italy
Roberto Amore Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, Chieti, Italy
Segio Rexhep Tari Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, Via Dei Vestini 31, 66100, Chieti, Italy
Iris Alla Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, Via Dei Vestini 31, 66100, Chieti, Italy

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Impact of SARS-CoV-2 Vaccination or Infection on the Safety and Efficacy of Aesthetic Injections: A Systematic Review

BACKGROUND

Aesthetic injections have become increasingly popular for maintaining a youthful appearance. However, with the rise of SARS-CoV-2, there have been concerns about potential complications. This study aims to summarize and understand the complications that occur in individuals who have received cosmetic injections after SARS-CoV-2 infection or vaccination. By doing so, we hope to provide recommendations to minimize these complications and ensure the safety of aesthetic treatments in the current COVID-19 era.

METHODS

The PRISMA guidelines, the Preferred Reporting Program for Systematic Reviews and Meta-Analyses, were used for this review. Databases including PubMed, EMBASE, Medline, Web of Science and ScienceDirect were searched. The last search time of each database was May 10, 2023. In addition, relevant references were manually searched.

RESULTS

A total of 26 studies containing 139 patients were searched. The complication with the highest percentage of reported patients was delayed inflammatory response (DIR) (n = 68; 48.92%), followed by diminished efficacy (n = 45; 32.37%) and filler reaction (n = 12; 8.63%). The remaining complications include hypersensitivity reactions, symptomatic hypercalcemia, sub-acute hypersensitive reactions, hyperalgesia, infection, fat necrosis and granulomatous reaction.

CONCLUSIONS

Cosmetic injectable procedures are generally safe but may have adverse effects, particularly during the pandemic. It is important for individuals to fully understand these risks beforehand. Clinicians should be knowledgeable about adverse event mechanisms and management to prevent issues. Industry leaders should strengthen risk management efforts to ensure safe and steady development of cosmetic injections. Overall, a comprehensive understanding, effective communication and risk management are crucial for the safe use of cosmetic injectable procedures.

LEVEL OF EVIDENCE III

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 at www.springer.com/00266 .

Innovative Non-Surgical Plastic Technique for Saddle Nose Correction: A Study on 97 Patients

Background: Non-surgical rhinoplasty is one of the best choices in mild cases of the saddle nose, and it represents a solution for the aesthetical amelioration of facial deformity; nevertheless, in most critical cases, surgical intervention is still required. This study reports the experience and results of a single facial plastic surgeon (M.G.) using a non-surgical technique for the correction of saddle noses in a large cohort of patients. Methods: This retrospective study assesses all patients injected from January 2017 through October 2023 in private clinics in Milan (Italy), London (UK), and Dubai (UAE). All patients were followed up for 12 months. The harvested adipose tissues were processed with different systems and with or without acoustic wave therapy (AWT). The extracted products have been characterized in terms of cellular yield and cell growth. Ninety-seven patients were injected with adipose-derived products or hyaluronic acid (HA). Patients were followed up for 12 months, and satisfaction data were analyzed. Results: The stem cells obtained from the patients who previously received AWT displayed a statistically higher cell growth ability in comparison with those of the cells derived from patients who did not receive AWT. The evolution of patient satisfaction during the time for each group of treatment was investigated, and cellular treatments show the best maintenance of patient satisfaction over time. Conclusions: Dermgraft and AWT approaches resulted in the highest patient satisfaction for the non-surgical correction of the saddle nose deformity.

Ultrasound assessment of the nose vasculature: A review of the common method of non-surgical filler-based rhinoplasty

BACKGROUND

With the increasing use of dermal injectable fillers in aesthetic medicine, the popularity of non-surgical filler-based rhinoplasty (NSR) is also growing. While performing this procedure might result in certain vascular complications, injecting deep into the midline of the nose is commonly considered the safest method for blind primary NSR.

AIMS

In this study, we challenged the common NSR method with a Doppler ultrasound study of the nose.

PATIENTS/METHODS

The vascular pattern of the common zones of the NSR procedure (radix and nasal tip) of 21 Iranian women were investigated by using a 14 MHz Doppler handheld ultrasound device (Silarious L14PS). Participants had never undergone any procedure on their nose. We focused on the depth of midline vessels in the radix and nasal tip. The radix was studied sagittally and horizontally, and the nasal tip was examined axially by ultrasound.

RESULTS

In the radix of eight cases (38%), at least one vessel was observed at midline, and all were superficial. In the nose tip of 18 cases (86%), at least one vessel was observed at midline, and 9 out of these 18 vessels (50%) were deep. As a result, conducting NSR by the common method in our study population was relatively safe in the radix, but there was an increased likelihood of vascular events in the tip.

CONCLUSION

Our research results show that while the common method of the NSR may carry a high risk of vascular events, the safety of this procedure could be enhanced by using ultrasound for planning and conducting a tailored treatment.

Nonsurgical rhinoplasty using the hyaluronic acid filler VYC-25L: Safety and patient satisfaction in a retrospective analysis of 492 patients

BACKGROUND

Aesthetic treatment of the nose with hyaluronic acid (HA) fillers is increasingly popular but carries a small risk of major complications. Large patient cohorts are required to better understand this risk.

AIMS

To evaluate safety and patient satisfaction in a large series of nonsurgical rhinoplasty treatments with the HA filler, VYC-25L, in "real world" clinical practice.

METHODS

This was a retrospective analysis of consecutive adult patients undergoing nonsurgical rhinoplasty with VYC-25L by a single injector between January 2020 and July 2022. All patients received initial treatment (typically ~0.3-0.5 mL of filler) and touch-up at 4-6 weeks (~0.1-0.3 mL). Safety data were collected throughout a mean follow-up of 11.1 months. Patient satisfaction was assessed using the FACE-Q Satisfaction with Nose and Satisfaction with Outcome questionnaires.

RESULTS

A total of 492 patients were included (984 treatment sessions including touch-ups). Of these, 467 (94.9%) were female and the mean age was 30.0 years. All treatments were associated with early transient edema; other adverse events included bruising (n = 123; 25%), residual asymmetry (n = 18; 3.7%), and suspected localized vascular occlusion (n = 3; 0.6%). The latter cases were easily resolved with hyaluronidase injection plus oral steroid and aspirin. No patients experienced infection, necrosis, blindness, lumps, granuloma, or delayed-onset nodules. Mean Rasch-transformed FACE-Q scores were 90.2% for Satisfaction with Nose and 99.2% for Satisfaction with Outcome.

CONCLUSIONS

In a large cohort of patients treated in routine practice based on a systematic approach, nonsurgical rhinoplasty with VYC-25L was safe and effective.

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

INTRODUCTION

In cosmetic practices, non-surgical rhinoplasty using filler injections has become increasingly common. Nevertheless, the outcome and overall complications have not been studied as a systematic review in the literature. This study provides a high-quality systematic review of studies reporting clinical and patient-reported outcomes following non-surgical rhinoplasty with hyaluronic acid (HA) to further guide practitioners.

METHODS

This systematic review was conducted in accordance with PRISMA guidelines and was registered in PROSPERO. The search was conducted using MEDLINE, EMBASE, and Cochrane. The literature retrieval was conducted by three independent reviewers, and the remaining articles were screened by two independent reviewers. The quality of included articles was assessed using the MINORS and methodological quality and synthesis of case series and case reports tools.

RESULTS

A total of 874 publications were found based on the search criteria. A total of 3928 patients were reviewed for this systematic review from 23 full-text articles. For non-surgical rhinoplasty, Juvéderm ultra was the most commonly used HA filler. The nasal tip was most commonly injected (13 studies), followed by the columella (12 studies). Nasal hump deformities are the most common reason for non-surgical rhinoplasty. All studies showed high patient satisfaction. Among all patients reviewed, eight developed major complications.

CONCLUSION

Non-surgical rhinoplasty performed with HA has minimal side effects and a short recovery period. Furthermore, non-surgical rhinoplasty with HA results in high satisfaction. To strengthen the presently available evidence, further well-designed RCTs are needed.

LEVEL OF EVIDENCE III

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 https://www.springer.com/00266.

Nonsurgical rhinoplasty

Interest in liquid, or nonsurgical rhinoplasty, has increased in demand as patients pursue less invasive techniques to achieve their aesthetic goals. Improved filler technology and refinement in injection techniques have made liquid rhinoplasty a reasonable choice for well-selected patients in both primary and revision rhinoplasty cases. This article reviews nasal anatomy, injection techniques, selected applications, and safety measures pertinent to performing nonsurgical rhinoplasty.

Biological Changes of Autologous Auricular Cartilage in Rhinoplasty

Autologous auricular cartilage is used extensively as a good graft material in rhinoplasty. In this study, clinical specimens from patients who underwent revision rhinoplasty with auricular cartilage grafts were collected to compare the changes before and after auricular cartilage transplantation with the use of histologic, immunohistochemical, and quantitative assays. Patients who underwent revision rhinoplasty from 2018 to 2022 were analyzed. Fresh auricular cartilage left after surgery and auricular cartilage graft tissue were examined and compared. Compared with fresh auricular cartilage, local fibrosis was seen in the transplanted auricular cartilage with a slight decrease in elastic fibers, type II collagen, and extracellular matrix secretion. Quantitative assays showed a decrease in glycosaminoglycan, DNA, and total collagen content in the transplanted auricular cartilage tissue. The results of the study suggest that the histologic characteristics, cell functionality, and biochemical composition of the grafted cartilage changed to a certain extent after autologous auricular cartilage graft rhinoplasty. These results provide insights into the selection of graft/filler materials for rhinoplasty and what changes to expect.

Postoperative Fillers Reduce Revision Rates in Rhinoplasty

Background

Rhinoplasty is a complex procedure with revision rates of up to 17%. Even minor imperfections after surgery can be significant.

Objectives

This review aims to investigate the use of hyaluronic acid (HA) fillers postaesthetic rhinoplasty and assess the rhinoplasty practice of the senior author.

Methods

From the senior author's practice, case records were obtained for patients who underwent surgery followed by nonsurgical rhinoplasty between 2015 and 2022. Data were retrospectively obtained and analyzed. The variables measured included the number of patients treated with fillers postoperatively, volume and type of filler used, locations of injection, and frequency of injections and complications.

Results

Eight hundred patients underwent rhinoplasty between March 2015 and March 2022, and 10.6% (n = 85) of these underwent nonsurgical rhinoplasty using the HA filler for postoperative imperfections. The Juvederm 2 filler (Allergan, Irvine, CA) was mainly used with a mean volume of 0.2 mL. A total of 11.8% (n = 10) of patients had fillers for a second time and 3.5% (n = 3) required a third filler. The majority of patients had fillers in the rhinon area (82.3%; n = 70), and no complications were reported, with patient satisfaction levels being good.

Conclusions

Often, there is hesitancy to use fillers after surgery due to the assumption that fillers will be required in the long term and complication rates can be high for postrhinoplasty nose fillers. From our series, we conclude that after surgery, fillers last for a greater time period than those used purely for primary augmentation. Hence, the authors recommend rhinoplasty surgeons to consider HA filler use for patients troubled by postsurgery surface irregularities.

Level of Evidence 5

Nonsurgical rhinoplasty: prevention and management of associated complications

PURPOSE OF REVIEW

Nonsurgical rhinoplasty (NSR) continues to grow in demand and popularity. Consequently, there has been a rise in the number of reported complications. This review will summarize and discuss the current evidence for the prevention and management of adverse events related to NSR with a specific emphasis on practical clinical applications. The review is based on recent systematic reviews and multidisciplinary expert consensus recommendations.

RECENT FINDINGS

First, NSR has overall favorable outcomes with rare complications. Second, vascular compromise is a rare event, but the number of reported severe complications is rising. Third, providers should be intimately familiar with preventive measures, early signs and symptoms, and appropriate management algorithms of all possible complications. Fourth, having a readily available 'toolbox' of recommended therapies may improve timely management of emergent complications.

SUMMARY

The number of complications associated with NSR is expected to rise congruent with the increased demand for the procedure. Although NSR has a favorable safety profile, complications can occur in the best of hands even when using appropriate risk reduction strategies. Early detection and appropriate treatment of known complications may eliminate or minimize sequelae and allow providers to continue to safely perform NSR.

Presentation Patterns and Surgical Management of the Complications of Thread Rhinoplasty

Objectives

Nonsurgical rhinoplasty using threads has gained popularity in recent years. While the benefits of this procedure have been emphasized, possible complications and their management are not well-known. This study aimed to present the surgical management and results of the complications of thread rhinoplasty.

Methods

We retrospectively reviewed the medical records of seven patients who underwent revision rhinoplasty due to the complications of thread rhinoplasty from January 2018 to May 2021. The presentation of complications, detailed surgical procedures, and outcomes of revision rhinoplasty were reviewed.

Results

Visible or extruded threads at the tip were the most common complication, followed by dorsum irregularity. All the threads were unabsorbed and intact in shape, even several years after insertion. Thread removal necessitated careful tissue dissection, resulting in the loss of tip support and dorsal irregularity. To restore the tip support and camouflage the dorsum shape, an autologous tissue graft was needed.

Conclusion

Removal of threads at the tip and dorsum was accompanied by structural weakening and partial tissue loss, which required tip support restoration and dorsum camouflage.

Ethnicity and Nonsurgical Rhinoplasty

Background

Nonsurgical rhinoplasty is a procedure that is gaining popularity in aesthetic clinics particularly because of its minimally invasive nature compared with surgery. It is recognized that there are ethnic variations in nose injection techniques and planned aesthetic outcomes.

Objectives

The objective of this study was to explore experts' views about the ethnic differences in the anatomical features of the nose and procedure-related considerations in nonsurgical rhinoplasty.

Methods

Using a priori set topics and questions, 4 expert aesthetic physicians, from 4 different ethnic backgrounds and working in 4 different regions, were asked to describe the essential elements to be considered when planning a nonsurgical rhinoplasty, including product choice, injection technique, safety measures, and any practical hints to facilitate achieving the desired outcome.

Results

All invited experts responded to the full set of questions. There were similarities between the treating physicians in some of the technical steps. Nevertheless, there were several differences identified regarding baseline anatomy and patient expectations that could be attributed to ethnicity. Patients' and physicians' expectations regarding a successful nonsurgical rhinoplasty can vary depending on their ethnic backgrounds. Therefore, with the current global ethnic and cultural diversities, in addition to the knowledge of the nasal anatomy and safe injection techniques, it is imperative that aesthetic practitioners have full awareness and a good understanding of these ethnic variations.

Conclusions

Nonsurgical rhinoplasty is a highly demanded aesthetic procedure. Patients' ethnic differences need to be carefully taken into consideration when discussing, planning, and performing nasal fillers injection.