Nonsurgical Approach to Treat Post-Rhinoplasty Vascular Complication With Hyaluronic Acid Injection

Hyaluronic acid (HA) fillers are popular for their minimally invasive nature and immediate aesthetic outcomes, but vascular compromise remains a significant complication. This study investigates optimized therapeutic strategies to prevent tissue necrosis following HA filler injections.

To evaluate the efficacy of two treatment regimens for managing impending nasal skin necrosis due to HA filler injections, focusing on preventing tissue necrosis and reducing complications such as pigmentation changes, scarring, and telangiectasia.

A retrospective analysis was conducted on 41 female patients (mean age: 36.2 years) treated at a single referral center between 2018 and 2023. Patients presented within 72 h after developing ischemic symptoms following HA injections for nasal augmentation. Two treatment regimens, both integrating hyperbaric oxygen therapy (HBOT), epidermal growth factor (EGF) gel, and corticosteroids, were evaluated: one using nitroglycerin (NTG) and the other using isosorbide dinitrate (ISDN).

All patients achieved complete wound healing, with no significant differences in scar formation or hypotension between the treatment groups (p > 0.05). Hyaluronidase (HSE) was administered externally at referring clinics prior to hospital admission in 31.7% of patients (without subsequent standardized HSE protocol), significantly reducing telangiectasia incidence (p < 0.05) but not affecting scarring or pigmentation (p > 0.05). Early hospital presentation (< 48 h) was associated with lower pigmentation changes (p < 0.05) but did not significantly affect scarring. Residual complications included scar formation in 9 of 41 patients (21.9%, 95% CI 12.0-36.7), telangiectasia in 16 of 41 (39.0%, 95% CI 25.7-54.3), and pigmentation changes in 22 of 41 (53.7%, 95% CI 38.7-67.9).

Combined therapies effectively manage HA-induced vascular compromise, with early intervention critical for reducing ischemic complications and improving patient outcomes.