Surgical Management of Filler Rhinoplasty Complications

The increasing use of filler rhinoplasty has led to more patients presenting with complications such as fibrosis, granuloma formation, skin irregularities, and filler migration, including the characteristic "Avatar nose." These cases require a systematic, algorithm-driven approach for safe and predictable correction.

Nonsurgical rhinoplasty has gained popularity due to its minimally invasive nature, yet complications requiring surgery have become increasingly recognized.

Distorted soft-tissue planes and altered skin-soft-tissue envelopes (SSTE) after filler placement influence both dissection and reconstruction.

High-frequency ultrasound can assist in identifying residual filler and guiding hyaluronidase dissolution before surgery.

Patients with persistent deformity, migration, granuloma, or long-standing fillers unresponsive to nonsurgical measures are appropriate surgical candidates.

Revision rhinoplasty involves open approaches, selective removal of residual filler, and structural reconstruction with autologous cartilage. Redundant SSTE may require increased dorsal augmentation, conservative trimming, and adjunctive intraoperative doxycycline.

Postoperative corticosteroid injections can limit fibrosis and improve contour.

Algorithm-based evaluation and operative planning continue to refine management of these complex cases.

Thoughtful surgical execution is essential for achieving stable, natural outcomes in patients with filler-related nasal complications.