Safety in nonsurgical rhinoplasty: Clinical considerations based on a literature review

Nonsurgical rhinoplasty is a widely performed procedure but is still considered high-risk by many clinicians because of the potential for serious and potentially irreversible complications, including vascular compromise. This review aimed to identify and define clinical measures that may improve procedural safety for both clinicians and patients.

A narrative literature review was conducted. The PubMed/MEDLINE and Cochrane databases were searched for studies regarding nonsurgical rhinoplasty using hyaluronic acid (HA) fillers. The analysis focused on instruments used, preventive maneuvers, anatomical injection sites, and the characteristics of the HA fillers employed.

Of the 71 articles initially identified, 16 met the inclusion criteria. Key clinical considerations include appropriate needle or cannula selection, the use of high-G' HA fillers, deep midline injections with careful aspiration and stabilization, the use of a new needle for each injection, the slow administration of very small volumes, whether starting from lower-risk zones was considered, application of digital compression to limit filler spread, and increased caution in previously operated noses.

Fifteen clinical considerations that may contribute to improved safety in nonsurgical rhinoplasty were identified. However, the available evidence remains limited. Most recommendations throughout the literature are primarily based on expert opinions and detailed anatomical knowledge.