LAUSR

Rhinoplasty is one of the most popular facial aesthetic procedures but also one of the most technically challenging, with revision rates after surgical rhinoplasty ranging from 5% to 20%.1 The popularity of nonsurgical alternatives has been steadily increasing, especially that of injectable filler rhinoplasty using hyaluronic acid (HA), which offers reduced financial and anaesthetic impact, immediate aesthetic results, and rapid recovery.2 This is often demonstrated on video posts on social media platforms, which show immediate postprocedure results but often no further follow-up.3 Although fillers are predominantly used for aesthetic rhinoplasty, the technique has also been utilized to address functional issues including internal valve collapse.4 As the number of patients using injectable fillers increases, so too does the likelihood of adverse events such as skin necrosis and blindness. The chance of these complications occurring increases in patients who have had previous surgical rhinoplasty. This is due to unpredictable vasculature increasing the risk of vessel cannulation, and subsequently vascular thrombosis and ischaemia.1 There is no consensus on treatment algorithms for filler rhinoplasty; no definitive inclusion or exclusion criteria; no consensus on which brand of HA to use, how much to use, which areas to inject, which to avoid, follow-up duration for safety, or aesthetic outcomes. Specific target areas to produce good results have been identified,5 such as injecting the columella base to widen the nasolabial angle and reshape the tip, and injecting the supratip and radix to straighten the dorsum (Figure 1). However, these are loose recommendations at best. To minimize complications, precautions such as utilizing blunt, small-bore cannulae, aspirating before injection, placing filler superficially, and using small quantities only are beneficial. In addition, deep injections into the musculoaponeurotic layers in the preperichondrial and preperiosteal layers minimize vessel cannulation.2 An Ovid Medline search for “filler rhinoplasty” retrieved only 7 retrospective studies, all of which presented minimal complications. However, 8 case reports were retrieved illustrating severe complications of filler rhinoplasty. We have summarized these data (Tables 1-2), which show limited follow-up and the potential for serious complications occurring. With the scarcity of long-term evidence and strict management algorithms, further large-scale studies need to be conducted. This will provide more robust support for filler rhinoplasty as an alternative to traditional surgical rhinoplasty. There is a place for filler rhinoplasty as a nonsurgical alternative. Many key plastic surgery training texts and programs do not teach these techniques to plastic surgeons, and they remain firmly in the realm of other specialties that may have better training in this area.5