Management of Patients Seeking Surgical Rhinoplasty with Previous Nasal Injections of Hyaluronic Acid



Patients are looking for procedures which are minimally invasive and consequently incur minimal downtime. However, these procedures are not usually long lasting and have limited outcomes both esthetically and functionally. For these reasons, the number of patients seeking surgical rhinoplasty and who have previous nasally injected hyaluronic acid is increasing.


The aim of this article is to provide the surgeon with information for both the identification and surgical approach for those patients who seek nasal cosmetic surgery, and who have previously been treated with nasal injections of hyaluronic acid filler.


We present cases that illustrate the use of this approach and suggest three possible patient management.


There are three possible approaches: wait HA to be naturally reabsorbed; apply hyaluronidase before the surgery or proceed to rhinoplasty with no prior application of hyaluronidase. The physician must be aware of this progression and know how to manage each case to optimize the surgical outcome.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

available at video (1). All images were obtained with EPIQ7 equipment (Philips Medical Systems, Bothell, WA, USA), and two high frequency transducers (7–15 MHz and 4–18 MHz) were used


  1. 1.

    American Society of Plastics Surgeons (2018) Plastic surgery statistics report. 2018 plastic surgery statistics, ASPS Public Relations

  2. 2.

    Thomas WW, Bucky L, Friedman O (2016) Injectables in the nose: facts and controversies. Facial Plast Surg Clin N Am 24:379–389

    Article  Google Scholar 

  3. 3.

    Kontis TC (2017) Nonsurgical rhinoplasty. JAMA Facial Plast Surg 19:430–431

    Article  Google Scholar 

  4. 4.

    Greene JJ, Sidle DM (2015) The hyaluronic acid fillers: current understanding of the tissue device interface. Facial Plast Surg Clin N Am 23:423–432

    Article  Google Scholar 

  5. 5.

    Ramos HHA, Bernardino IPL, Rocha RCC (2020) Hyaluronic acid filler in the treatment for drooping tip: anatomical concepts and clinical results. Aesthet Plast Surg.

    Article  Google Scholar 

  6. 6.

    Liew S, Scamp T, de Maio M, Halstead M, Johnston N, Silberberg M, Rogers JD (2016) Efficacy and safety of a hyaluronic acid filler to correct aesthetically detracting or deficient features of the Asian nose: a prospective, open-label, long-term study. Aesthet Surg J 36(7):760–772

    Article  Google Scholar 

  7. 7.

    Daniel RK, Letourneau A (1988) Rhinoplasty: nasal anatomy. Ann Plast Surg 20:5–13

    CAS  Article  Google Scholar 

  8. 8.

    Dey JK, Recker CA, Olson MD, Bowen AJ, Panda A, Kostandy PK, Lane JI, Hamilton GS 3rd (2019) Assessing nasal soft-tissue envelope thickness for rhinoplasty: normative data and a predictive algorithm. JAMA Facial Plast Surg 21:511–517

    Article  Google Scholar 

  9. 9.

    Tansatit T, Apinuntrum P, Phetudom T (2017) Facing the worst risk: Confronting the dorsal nasal artery, implication for non-surgical procedures of nasal augmentation. Aesthet Plast Surg 41:191–198

    Article  Google Scholar 

  10. 10.

    Lee W, Kim J-S, Oh W, Koh I-S, Yang E-J (2019) Nasal dorsum augmentation using soft tissue filler injection. J Cosmet Dermatol.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Cavallieri FA (2020) Advantages of sonography in fillers and complications. In: Bard RL (ed) Image Guided Dermatologic Treatments. Springer International Publishing, Cham, pp 93–101.

    Google Scholar 

  12. 12.

    Jones D, Tezel A, Borrell M (2010) In vitro resistance to degradation of hyaluronic acid dermal fillers by ovine testicular hyaluronidase. Dermatol Surg 36:804–809

    CAS  Article  Google Scholar 

  13. 13.

    Landau M (2015) Hyaluronidase caveats in treating filler complications. Dermatol Surg 41:S347

    Article  Google Scholar 

  14. 14.

    Herrmann JL, Hoffmann RK, Ward CE, Schulman JM, Grekin RC (2018) Biochemistry, physiology, and tissue interactions of contemporary biodegradable injectable dermal fillers. Dermatol Surg 44(1):S19–S31

    CAS  Article  Google Scholar 

  15. 15.

    Quezada-Gaón N, Wortsman X (2016) Ultrasound-guided hyaluronidase injection in cosmetic complications. J Eur Acad Dermatol Venereol 30:e39–e40

    Article  Google Scholar 

Download references


The authors received no financial support for the research, authorship, and publication of this article.

Author information



Corresponding author

Correspondence to Helena Hotz Arroyo Ramos.

Ethics declarations

Conflict of interest

The authors declare no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

All patients provided written consent for the use of their images.

Additional information

Publisher's Note

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

Supplementary information

ESM1 (MPG 1,91,666 kb)

ESM2 (MP4 34,118 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ramos, H.H.A., Freire, L., Cavallieri, F. et al. Management of Patients Seeking Surgical Rhinoplasty with Previous Nasal Injections of Hyaluronic Acid. Aesth Plast Surg (2021).

Download citation


  • Rhinoplasty
  • Nose
  • Filler
  • Nonsurgical rhinoplasty
  • Surgical rhinoplasty
  • Hyaluronic acid filler
  • injectables