Skip to main content

Advertisement

SpringerLink
Log in

Hyaluronidase injection vs direct surgery in surgical rhinoplasty patients treated with non-surgical nasal reshaping with hyaluronic acid filler: a systematic review

  • Review
  • Published:
European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Non-surgical nasal reshaping with hyaluronic acid filler is a well-established procedure performed in order to ameliorate nasal appearance and considered a valid alternative to surgical rhinoplasty in selected patients. The aim of this systematic review is to evaluate, in patients looking for surgical rhinoplasty who already received nSNR with HA, if hyaluronidase injection before surgery is to prefer instead of direct surgery in order to reduce/avoid intra-operative troubles in performing a rhinoplasty.

Methods

The literature search was carried out on electronic PubMed and Cochrane Library databases identifying 567 articles up to May 19th, 2021. Number of patients, outcomes and complications were extracted.

Results

Three retrospective articles were eligible for inclusion in the review. Thirteen patients were operated on for rhinoplasty who previously received nSNR with HA. Six received hyaluronidase injections before surgery and 7 underwent directly to surgery. Among the 7 who went straight to surgery, in 5 of them, 6 months was the specified time lapse between last HA injection and surgery. Among the ones receiving hyaluronidase injection before surgery, the time lapse reported was 6 months for 1 patient, 3 months for 2 patients, 2 months for 1 patient and 7 days for 1 patient. Post-operative complications were not recorded.

Conclusions

Either direct surgical approach or hyaluronidase injection first seems to be a viable option with the total absence of post-operative complications. When direct surgery is preferred, it could be demanding and customized informed consent should be released to the patients prior to surgery.

Level of evidence: Not gradable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

Data are available upon request.

References

  1. de Lacerda DA, Zancanaro P (2007) Filler rhinoplasty. Dermatol Surg. 33(Suppl 2):S207-212. https://doi.org/10.1111/j.1524-4725.2007.33362.x (discussion S212, Dec)

    Article  CAS  PubMed  Google Scholar 

  2. Kumar V, Jain A, Atre S, Shome D, Kapoor R, Doshi K, Vadera S (2021) Non-surgical rhinoplasty using hyaluronic acid dermal fillers: a systematic review. J Cosmet Dermatol. https://doi.org/10.1111/jocd.14173.Apr26

    Article  PubMed  PubMed Central  Google Scholar 

  3. Harb A, Brewster CT (2020) The nonsurgical rhinoplasty: a retrospective review of 5000 treatments. Plast Reconstr Surg 145:661–667. https://doi.org/10.1097/PRS.0000000000006554

    Article  CAS  PubMed  Google Scholar 

  4. Beer KR (2006) Nasal reconstruction using 20 mg/ml cross-linked hyaluronic acid. J Drugs Dermatol 5:465–466

    PubMed  Google Scholar 

  5. Rauso R, Tartaro G, Chirico F, Zerbinati N, Albani G, Rugge L (2020) Rhinofilling with hyaluronic acid thought as a cartilage graft. J Craniomaxillofac Surg 48:223–228. https://doi.org/10.1016/j.jcms.2020.01.008

    Article  PubMed  Google Scholar 

  6. Bertossi D, Malchiodi L, Albanese M, Nocini R, Nocini P (2021) Nonsurgical rhinoplasty with the novel hyaluronic acid filler VYC-25L: results using a nasal grid approach. Aesthet Surg J 41:NP512–NP520. https://doi.org/10.1093/asj/sjaa196

    Article  PubMed  Google Scholar 

  7. Ramos HHA, Bernardino IPL, de Cassia Capelato Rocha R (2020) Hyaluronic acid filler in the treatment for drooping tip: anatomical concepts and clinical results. Aesthetic Plast Surg 44:2173–2182. https://doi.org/10.1007/s00266-020-01836-6

    Article  PubMed  Google Scholar 

  8. Rivkin A (2021) Nonsurgical rhinoplasty using injectable fillers: a safety review of 2488 procedures. Facial Plast Surg Aesthet Med 23:6–11. https://doi.org/10.1089/fpsam.2020.0291

    Article  PubMed  Google Scholar 

  9. Rosengaus F, Nikolis A (2020) Cannula versus needle in medical rhinoplasty: the nose knows. J Cosmet Dermatol 19:3222–3228. https://doi.org/10.1111/jocd.13743

    Article  PubMed  Google Scholar 

  10. Bektas G, Cinpolat A, Rizvanovic Z (2020) Nasal filling in plastic surgery practice: primary nasal filling, nasal filling for post-rhinoplasty defects, rhinoplasty after hyaluronidase injection in dissatisfied nasal filling patients. Aesthetic Plast Surg 44:2208–2218. https://doi.org/10.1007/s00266-020-01895-9

    Article  PubMed  Google Scholar 

  11. Jung GS (2019) Filler rhinoplasty based on anatomy: the dual plane technique. JPRAS Open 20:94–100. https://doi.org/10.1016/j.jpra.2019.04.002

    Article  PubMed  PubMed Central  Google Scholar 

  12. Rauso R, Colella G, Zerbinati N, Salti G (2017) Safety and early satisfaction assessment of patients seeking nonsurgical rhinoplasty with filler. J Cutan Aesthet Surg 10:207–214. https://doi.org/10.4103/JCAS.JCAS_89_17

    Article  PubMed  PubMed Central  Google Scholar 

  13. Di Rosa L, Cerulli G, De Pasquale A (2020) Psychological analysis of non-surgical rhinoplasty. Aesthetic Plast Surg 44:131–138. https://doi.org/10.1007/s00266-019-01538-8

    Article  PubMed  Google Scholar 

  14. Jung GS (2019) Clinical aesthetics of the nose for filler injection. Facial Plast Surg 35:561–562. https://doi.org/10.1055/s-0039-1696991

    Article  CAS  PubMed  Google Scholar 

  15. Mehta U, Fridirici Z (2019) Advanced techniques in nonsurgical rhinoplasty. Facial Plast Surg Clin North Am 27:355–365. https://doi.org/10.1016/j.fsc.2019.04.008

    Article  PubMed  Google Scholar 

  16. Lee W, Kim JS, Oh W, Koh IS, Yang EJ (2019) Nasal dorsum augmentation using soft tissue filler injection. J Cosmet Dermatol. https://doi.org/10.1111/jocd.13018

    Article  PubMed  PubMed Central  Google Scholar 

  17. Tanaka Y (2014) Oriental nose occidentalization and perinasal shaping by augmentation of the underdeveloped anterior nasal spine. Plast Reconstr Surg Glob Open 2:e197. https://doi.org/10.1097/GOX.0000000000000161

    Article  PubMed  PubMed Central  Google Scholar 

  18. Bouaoud J, Belloc JB (2020) Use of injectables in rhinoplasty retouching: towards an evolution of surgical strategy? Literature review. J Stomatol Oral Maxillofac Surg 121:550–555. https://doi.org/10.1016/j.jormas.2020.03.008

    Article  CAS  PubMed  Google Scholar 

  19. Heden P (2016) Nasal reshaping with hyaluronic acid: an alternative or complement to surgery. Plast Reconstr Surg Glob Open 4:e1120. https://doi.org/10.1097/GOX.0000000000001120

    Article  PubMed  PubMed Central  Google Scholar 

  20. Mashiko T, Mori H, Kato H, Doi K, Kuno S, Kinoshita K, Kunimatsu A, Ohtomo K, Yoshimura K (2013) Semipermanent volumization by an absorbable filler: onlay injection technique to the bone. Plast Reconstr Surg Glob Open 1 https://doi.org/10.1097/GOX.0b013e31828c66b0

  21. Salti G, Rauso R (2015) Facial rejuvenation with fillers: the dual plane technique. J Cutan Aesthet Surg 8:127–133. https://doi.org/10.4103/0974-2077.167264

    Article  PubMed  PubMed Central  Google Scholar 

  22. Rauso R, Federico F, Zerbinati N, De Cicco D, Nicoletti GF, Tartaro G (2020) Hyaluronic acid injections to correct lips deformity following surgical removal of permanent implant. J Craniofac Surg 31:e604–e606. https://doi.org/10.1097/SCS.0000000000006689

    Article  PubMed  Google Scholar 

  23. Mashiko T, Kinoshita K, Kanayama K, Feng J, Yoshimura K (2015) Perpendicular strut injection of hyaluronic acid filler for deep wrinkles. Plast Reconstr Surg Glob Open 3:e567. https://doi.org/10.1097/GOX.0000000000000552

    Article  PubMed  PubMed Central  Google Scholar 

  24. Rauso R, Zerbinati N, Franco R, Chirico F, Ronchi A, Sesenna E, Colella G, Tartaro G (2020) Cross-linked hyaluronic acid filler hydrolysis with hyaluronidase: different settings to reproduce different clinical scenarios. Dermatol Ther 33:e13269. https://doi.org/10.1111/dth.13269

    Article  CAS  PubMed  Google Scholar 

  25. Grunebaum LD, Bogdan Allemann I, Dayan S, Mandy S, Baumann L (2009) The risk of alar necrosis associated with dermal filler injection. Dermatol Surg 35(Suppl2):1635–1640. https://doi.org/10.1111/j.1524-4725.2009.01342.x

    Article  CAS  PubMed  Google Scholar 

  26. Kim SN, Byun DS, Park JH, Han SW, Baik JS, Kim JY, Park JH (2014) Panophthalmoplegia and vision loss after cosmetic nasal dorsum injection. J Clin Neurosci 21:678–680. https://doi.org/10.1016/j.jocn.2013.05.018

    Article  PubMed  Google Scholar 

  27. Rauso R, Sesenna E, Fragola R, Zerbinati N, Nicoletti GF, Tartaro G (2020) Skin necrosis and vision loss or impairment after facial filler injection. J Craniofac Surg 31:2289–2293. https://doi.org/10.1097/SCS.0000000000007047

    Article  PubMed  Google Scholar 

  28. Honart JF, Duron JB, Mazouz Dorval S, Rausky J, Revol M (2013) A case of nasal tip necrosis after hyaluronic acid injection. Ann Chir Plast Esthet 58:676–679. https://doi.org/10.1016/j.anplas.2013.08.005

    Article  PubMed  Google Scholar 

  29. Rauso R, Zerbinati N, Fragola R, Nicoletti GF, Tartaro G (2020) Transvascular hydrolysis of hyaluronic acid filler with hyaluronidase: an ex vivo study. Dermatol Surg. https://doi.org/10.1097/DSS.0000000000002773

    Article  Google Scholar 

  30. Wibowo A, Kapoor KM, Philipp-Dormston WG (2019) Reversal of post-filler vision loss and skin ischaemia with high-dose pulsed hyaluronidase injections. Aesthetic Plast Surg 43:1337–1344. https://doi.org/10.1007/s00266-019-01421-6

    Article  PubMed  Google Scholar 

  31. Cohen JL, Biesman BS, Dayan SH, DeLorenzi C, Lambros VS, Nestor MS, Sadick N, Sykes J (2015) Treatment of hyaluronic acid filler-induced impending necrosis with hyaluronidase: consensus recommendations. Aesthet Surg J 35:844–849. https://doi.org/10.1093/asj/sjv018

    Article  PubMed  Google Scholar 

  32. Rauso R, Colella G, Franco R, Chirico F, Ronchi A, Federico F, Volpicelli A, Tartaro G (2019) Is hyaluronidase able to reverse embolism associated with hyaluronic acid filler An anatomical case study. J Biol Regul Homeost Agents. 33:1927–1930. https://doi.org/10.23812/19-397-L

    Article  CAS  PubMed  Google Scholar 

  33. DeLorenzi C (2017) New high dose pulsed hyaluronidase protocol for hyaluronic acid filler vascular adverse events. Aesthet Surg J 37:814–825. https://doi.org/10.1093/asj/sjw251

    Article  PubMed  Google Scholar 

  34. Ramos HHA, Freire L, Cavallieri F, Frota AE, Ragazzo R, Jurado JRP (2021) Management of patients seeking surgical rhinoplasty with previous nasal injections of hyaluronic acid. Aesthetic Plast Surg. https://doi.org/10.1007/s00266-021-02136-3

    Article  PubMed  Google Scholar 

  35. Gubisch W, Hacker S (2021) Invited discussion on: “Management of Patients Seeking Surgical Rhinoplasty with Previous Nasal Injections of Hyaluronic Acid.” Aesthetic Plast Surg. https://doi.org/10.1007/s00266-021-02172-z

    Article  PubMed  Google Scholar 

  36. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71

    Article  PubMed  PubMed Central  Google Scholar 

  37. Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919. https://doi.org/10.1136/bmj.i4919

    Article  PubMed  PubMed Central  Google Scholar 

  38. McGuinness LA, Higgins JPT (2021) Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods 12:55–61. https://doi.org/10.1002/jrsm.1411

    Article  PubMed  Google Scholar 

  39. Zerbinati N, Lotti T, Monticelli D, Rauso R, Gonzalez-Isaza P, D’Este E, Calligaro A, Sommatis S, Maccario C, Mocchi R et al (2018) In vitro evaluation of the biosafety of hyaluronic acid PEG cross-linked with micromolecules of calcium hydroxyapatite in low concentration. Open Access Maced J Med Sci 6:15–19. https://doi.org/10.3889/oamjms.2018.044

    Article  PubMed  PubMed Central  Google Scholar 

  40. Gonzalez IP, Leibaschoff G, Esposito C, Cipolla G, Bader A, Lotti T, Tirant M, Van Thuong N, Ramo Abdulkader M, Rauso R et al (2019) Genitourinary syndrome of menopause and the role of biostimulation with non-cross-linked injectable hyaluronic acid plus calcium hydroxyapatite. J Biol Regul Homeost Agents 33:1961–1966. https://doi.org/10.23812/19-251-L

    Article  CAS  PubMed  Google Scholar 

  41. Zerbinati N, Haddad RG, Bader A, Rauso R, D’Este E, Cipolla G, Calligaro A, Gonzalez P, Salvatore S, Serafin D (2017) A new hyaluronic acid polymer in the augmentation and restoration of labia majora. J Biol Regul Homeost Agents 31:153–161

    CAS  PubMed  Google Scholar 

  42. Heden P (2020) Update on body shaping and volume restoration: the role of hyaluronic acid. Aesthetic Plast Surg 44:1295–1299. https://doi.org/10.1007/s00266-020-01772-5

    Article  PubMed  Google Scholar 

  43. Zerbinati N, Sommatis S, Maccario C, Capillo MC, Grimaldi G, Alonci G, Protasoni M, Rauso R, Mocchi R (2021) Toward physicochemical and rheological characterization of different injectable hyaluronic acid dermal fillers cross-linked with polyethylene glycol diglycidyl ether. Polymers (Basel) 13 https://doi.org/10.3390/polym13060948

  44. Rauso R, Nicoletti GF, Fragola R, Zerbinati N, Nikolli E, Bove P, Tartaro G (2021) Hyaluronidase use before rhinoplasty in noses previously injected with hyaluronic acid: is it always necessary? J Biol Regul Homeost Agents 35:775–777. https://doi.org/10.23812/21-118-L

    Article  CAS  PubMed  Google Scholar 

  45. Society TA Aesthetic Plastic Surgery National Databank Statistics 2020. Availabe online: (accessed on 16th June 2021)

  46. Sharma DSC, Lahiri MA (2021) Use of hyaluronidase in plastic surgery: a review. J Plast Reconstr Aesthet Surg. https://doi.org/10.1016/j.bjps.2021.03.125

    Article  PubMed  Google Scholar 

  47. Ryu C, Lu JE, Zhang-Nunes S (2021) Response of twelve different hyaluronic acid gels to varying doses of recombinant human hyaluronidase. J Plast Reconstr Aesthet Surg 74:881–889. https://doi.org/10.1016/j.bjps.2020.10.051

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, Via Luigi De Crecchio, 6, 80138, Naples, Italy

    Raffaele Rauso & Romolo Fragola

  2. Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, University of Campania “Luigi Vanvitelli”, Via Luigi De Crecchio, 6, 80138, Naples, Italy

    Giovanni Francesco Nicoletti

  3. Dermatology Department, University of Insubria, Via Guicciardini, 9, 21100, Varese, Italy

    Nicola Zerbinati

  4. Private Practice, Rome, Italy

    Pierfrancesco Cirillo, Valerio Finocchi & Michele Pascali

  5. Maxillofacial Surgery Department, Department of Oral and Maxillofacial Surgery, University of Verona, P.le L. Scuro 2, 37134, Verona, Italy

    Dario Bertossi

  6. Chirurgia della Bellezza, Via Melisugo 4, 80133, Naples, Italy

    Pierfrancesco Bove

  7. Department of Neurosciences, Reproductive and Odontostomatological Sciences, Maxillofacial Surgery Unit, University of Naples “Federico II”, Via Pansini, 5, 80131, Naples, Italy

    Giorgio Lo Giudice

Authors
  1. Raffaele Rauso
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Romolo Fragola
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giovanni Francesco Nicoletti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nicola Zerbinati
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pierfrancesco Cirillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dario Bertossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Valerio Finocchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michele Pascali
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Pierfrancesco Bove
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Giorgio Lo Giudice
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization, R.R. and P.B.; methodology, N.Z. and M.P.; data curation, P.C. and D.B.; investigation, R.F.; validation, V.F.; writing—original draft preparation, R.R.; writing—review and editing, G.L.G.; project administration, G.F.N. All authors have read and agreed to the final version of the manuscript.

Corresponding author

Correspondence to Giorgio Lo Giudice.

Ethics declarations

Ethics approval

This article is a review. No ethical approval is required.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

Raffaele Rauso, Romolo Fragola, Giovanni Francesco Nicoletti, Nicola Zerbinati, Pierfrancesco Cirillo, Dario Bertossi, Valerio Finocchi, Michele Pascali, Pierfrancesco Bove and Giorgio Lo Giudice declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rauso, R., Fragola, R., Nicoletti, G.F. et al. Hyaluronidase injection vs direct surgery in surgical rhinoplasty patients treated with non-surgical nasal reshaping with hyaluronic acid filler: a systematic review. Eur J Plast Surg 45, 383–392 (2022). https://doi.org/10.1007/s00238-021-01916-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00238-021-01916-z

Keywords

Search

Navigation