Skip to main content

Advertisement

SpringerLink
Log in

The Use of Hyaluronic Acid in Non-surgical Rhinoplasty: A Systematic Review of Complications, Clinical, and Patient-Reported Outcomes

  • Review
  • Non-Surgical Aesthetic
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Introduction

In cosmetic practices, non-surgical rhinoplasty using filler injections has become increasingly common. Nevertheless, the outcome and overall complications have not been studied as a systematic review in the literature. This study provides a high-quality systematic review of studies reporting clinical and patient-reported outcomes following non-surgical rhinoplasty with hyaluronic acid (HA) to further guide practitioners.

Methods

This systematic review was conducted in accordance with PRISMA guidelines and was registered in PROSPERO. The search was conducted using MEDLINE, EMBASE, and Cochrane. The literature retrieval was conducted by three independent reviewers, and the remaining articles were screened by two independent reviewers. The quality of included articles was assessed using the MINORS and methodological quality and synthesis of case series and case reports tools.

Results

A total of 874 publications were found based on the search criteria. A total of 3928 patients were reviewed for this systematic review from 23 full-text articles. For non-surgical rhinoplasty, Juvéderm ultra was the most commonly used HA filler. The nasal tip was most commonly injected (13 studies), followed by the columella (12 studies). Nasal hump deformities are the most common reason for non-surgical rhinoplasty. All studies showed high patient satisfaction. Among all patients reviewed, eight developed major complications.

Conclusion

Non-surgical rhinoplasty performed with HA has minimal side effects and a short recovery period. Furthermore, non-surgical rhinoplasty with HA results in high satisfaction. To strengthen the presently available evidence, further well-designed RCTs are needed.

Level of evidence III

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 the Table of Contents or the online Instructions to Authors https://www.springer.com/00266

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

References

  1. ISAPS (2023) Global survey 2020: full report and press releases (English). Retrieved 3 January 2023, from https://www.isaps.org/discover/about-isaps/global-statistics/reports-and-press-releases/global-survey-2020-full-report-and-press-releases-english/

  2. Rauso R, Tartaro G, Chirico F, Zerbinati N, Albani G, Rugge L (2020) Rhinofilling with hyaluronic acid thought as a cartilage graft. J Craniomaxillofacial Surg 48(3):223–228. https://doi.org/10.1016/j.jcms.2020.01.008

    Article  Google Scholar 

  3. Sahan A, Tamer F (2017) Non-surgical minimally invasive rhinoplasty: tips and tricks from the perspective of a dermatologist. Acta Dermatovenerol Alp Pannonica Adriat 26(4):101–103. https://doi.org/10.15570/actaapa.2017.29

    Article  PubMed  Google Scholar 

  4. Baptista C, Nguyen PS, Desouches C, Magalon G, Bardot J, Casanova D (2013) Correction of sequelae of rhinoplasty by lipofilling. J Plast Reconstr Aesthet Surg 66(6):805–811. https://doi.org/10.1016/j.bjps.2013.02.020

    Article  CAS  PubMed  Google Scholar 

  5. Erol OO (2017) Injection of compressed diced cartilage in the correction of secondary and primary rhinoplasty: a new technique with 12 years’ experience. Plast Reconstr Surg 140(5):673e–685e. https://doi.org/10.1097/PRS.0000000000003815

    Article  CAS  PubMed  Google Scholar 

  6. Kontis TC (2017) Nonsurgical rhinoplasty. JAMA Facial Plast Surg 19(5):430–431. https://doi.org/10.1001/jamafacial.2017.0701

    Article  PubMed  Google Scholar 

  7. Liew S, Scamp T, de Maio M et al (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. https://doi.org/10.1093/asj/sjw079

    Article  PubMed  PubMed Central  Google Scholar 

  8. DeVictor S, Ong AA, Sherris DA (2021) Complications secondary to nonsurgical rhinoplasty: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 165(5):611–616. https://doi.org/10.1177/0194599820987827

    Article  PubMed  Google Scholar 

  9. Mortada H, Seraj H, Barasain O, Bamakhrama B, Alhindi NI, Arab K (2022) Ocular complications post-cosmetic periocular hyaluronic acid injections: a systematic review. Aesthet Plast Surg 46(2):760–773. https://doi.org/10.1007/s00266-

    Article  Google Scholar 

  10. Johnson ON 3rd, Kontis TC (2016) Nonsurgical rhinoplasty. Facial Plast Surg 32(5):500–506. https://doi.org/10.1055/s-0036-1586209

    Article  CAS  PubMed  Google Scholar 

  11. Kumar V, Jain A, Atre S et al (2021) Non-surgical rhinoplasty using hyaluronic acid dermal fillers: a systematic review. J Cosmet Dermatol Sci 20(8):2414–2424. https://doi.org/10.1111/jocd.14173

    Article  Google Scholar 

  12. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Internal Med 151(4):64–64. https://doi.org/10.7326/0003-4819-151-4-200908180-00135

    Article  Google Scholar 

  13. National Institute for Health Research (NIHR) (2023) Prospero International prospective register of systematic reviews [database]. NIHR, Southampton

    Google Scholar 

  14. Thompson M, Tiwari A, Fu R, Moe E, Buckley DI (2012) A framework to facilitate the use of systematic reviews and meta-analyses in the design of primary research studies. Agency for Healthcare Research and Quality, Rockville

    Google Scholar 

  15. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A (2016) Rayyan-a web and mobile app for systematic reviews. Syst Rev 5(1):210. https://doi.org/10.1186/s13643-016-0384-4

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sullivan D, Chung KC, Eaves FF 3rd, Rohrich RJ (2011) The level of evidence pyramid: indicating levels of evidence in Plastic and Reconstructive Surgery articles. Plast Reconstr Surg 128(1):311–314. https://doi.org/10.1097/PRS.0b013e3182195826

    Article  CAS  PubMed  Google Scholar 

  17. Murad MH, Sultan S, Haffar S, Bazerbachi F (2018) Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med 23(2):60–63. https://doi.org/10.1136/bmjebm-2017-110853

    Article  PubMed  PubMed Central  Google Scholar 

  18. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716. https://doi.org/10.1046/j.1445-2197.2003.02748.x

    Article  PubMed  Google Scholar 

  19. Xue K, Chiang CA, Liu K, Gu B, Li Q (2012) Multiplane hyaluronic acid rhinoplasty. Plast Reconstr Surg 129(2):371e–372e. https://doi.org/10.1097/PRS.0b013e31823af0bd

    Article  CAS  PubMed  Google Scholar 

  20. Sun ZS, Zhu GZ, Wang HB et al (2015) Clinical outcomes of impending nasal skin necrosis related to nose and nasolabial fold augmentation with hyaluronic acid fillers. Plast Reconstr Surg 136(4):434e–441e. https://doi.org/10.1097/PRS.0000000000001579

    Article  CAS  PubMed  Google Scholar 

  21. Robati RM, Moeineddin F, Almasi-Nasrabadi M (2018) The risk of skin necrosis following hyaluronic acid filler injection in patients with a history of cosmetic rhinoplasty. Aesthet Surg J 38(8):883–888. https://doi.org/10.1093/asj/sjy005

    Article  PubMed  Google Scholar 

  22. 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. Aesthet Plast Surg 44(6):2208–2218. https://doi.org/10.1007/s00266-020-01895-9

    Article  Google Scholar 

  23. Kassir R, Venkataram A, Malek A, Rao D (2021) Non-surgical rhinoplasty: the ascending technique and a 14-year retrospective study of 2130 cases. Aesthet Plast Surg 45(3):1154–1168. https://doi.org/10.1007/s00266-020-02048-8

    Article  Google Scholar 

  24. Santorelli A, Marlino S (2020) Non-surgical rhinoplasty with hyaluronic acid fillers: predictable results using software for the evaluation of nasal angles. Aesthet Plast Surg 44(3):919–926. https://doi.org/10.1007/s00266-019-01579-z

    Article  Google Scholar 

  25. Rho NK, Park JY, Youn CS, Lee SK, Kim HS (2017) Early changes in facial profile following structured filler rhinoplasty: an anthropometric analysis using a 3-dimensional imaging system. Dermatol Surg 43(2):255–263. https://doi.org/10.1097/DSS.0000000000000972

    Article  CAS  PubMed  Google Scholar 

  26. Jung GS (2019) Filler rhinoplasty based on anatomy: the dual plane technique. J Plast Reconstr Aesthet Surg Open 20:94–100. https://doi.org/10.1016/j.jpra.2019.04.002

    Article  Google Scholar 

  27. Youn SH, Seo KK (2016) Filler rhinoplasty evaluated by anthropometric analysis. Dermatol Surg 42(9):1071–1081. https://doi.org/10.1097/DSS.0000000000000832

    Article  CAS  PubMed  Google Scholar 

  28. Han X, Hu J, Cheng L, Li F (2015) Multiplane hyaluronic acid (EME) in female Chinese rhinoplasty using blunt and sharp needle technique. J Plast Reconstr Aesthet Surg JPRAS 68(11):1504–1509. https://doi.org/10.1016/j.bjps.2015.06.020

    Article  PubMed  Google Scholar 

  29. Amore R, Donnamaria D, Marini F, Amuso D, Leonardi V, Di Vito Francesco M (2015) Nonsurgical rhinoplasty with injectable fillers: Italian technique for reshaping the tip of the nose. Am J Cosmet Surg 32(3):172–177

    Article  Google Scholar 

  30. Segreto F, Marangi GF, Cerbone V, Alessandri-Bonetti M, Caldaria E, Persichetti P (2019) Nonsurgical rhinoplasty: a graft-based technique. Plast Reconstr Surg Glob Open 7(6):e2241. https://doi.org/10.1097/GOX.0000000000002241

    Article  PubMed  PubMed Central  Google Scholar 

  31. 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(4):207–214. https://doi.org/10.4103/JCAS.JCAS_89_17

    Article  PubMed  PubMed Central  Google Scholar 

  32. 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(6):NP512–NP520. https://doi.org/10.1093/asj/sjaa196

    Article  PubMed  Google Scholar 

  33. Yordanov YP, Shef A (2019) Non-surgical correction of nasal dorsum and tip in primary cases. Acta Med Bulg 46(2):47–50

    Google Scholar 

  34. Helmy Y (2018) Non-surgical rhinoplasty using filler, Botox, and thread remodeling: retro analysis of 332 cases. J Cosmet Laser Ther 20(5):293–300. https://doi.org/10.1080/14764172.2017.1418509

    Article  PubMed  Google Scholar 

  35. Josipovic LN, Sattler S, Schenck TL, Sattler G (2022) Five-point liquid rhinoplasty: results from a retrospective analysis of a novel standardized technique and considerations on safety. J Cosmet Dermatol 21(11):5614–5620. https://doi.org/10.1111/jocd.15326

    Article  PubMed  Google Scholar 

  36. Schuster B (2015) Injection rhinoplasty with hyaluronic acid and calcium hydroxyapatite: a retrospective survey investigating outcome and complication rates. Facial Plast Surg 31(3):301–307. https://doi.org/10.1055/s-0035-1555628

    Article  CAS  PubMed  Google Scholar 

  37. Redaelli A (2008) Medical rhinoplasty with hyaluronic acid and botulinum toxin A: a very simple and quite effective technique. J Cosmet Dermatol 7(3):210–220. https://doi.org/10.1111/j.1473-2165.2008.00391.x

    Article  PubMed  Google Scholar 

  38. Hedén P (2016) Nasal reshaping with hyaluronic acid: an alternative or complement to surgery. Plast Reconstr Surg Global Open. https://doi.org/10.1097/GOX.0000000000001120

    Article  Google Scholar 

  39. Baser B, Singh P, Shubha P, Roy PK, Chaubey P (2021) Non-surgical rhinoplasty and use of hyaluronic acid based dermal filler-user experience in few subjects. Indian J Otolaryngol Head Neck Surg 73(1):52–58. https://doi.org/10.1007/s12070-020-02100-8

    Article  PubMed  Google Scholar 

  40. Demesh D, Cristel RT, Gandhi ND, Kola E, Issa TZ, Dayan SH (2022) Effects of hyaluronic acid filler injection for non-surgical rhinoplasty on first impressions and quality of life (FACE-Q scale). J Cosmet Dermatol 21(8):3351–3357. https://doi.org/10.1111/jocd.14980

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This work was supported by the College of Medicine Research Center, Deanship of Scientific Research, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia. We are thankful to the reviewers for their valuable comments and suggestions that helped improve the quality of this work.

Funding

The authors do not have any conflict of funding to declare.

Author information

Authors and Affiliations

  1. Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, Riyadh, Saudi Arabia

    Hatan Mortada

  2. Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia

    Hatan Mortada

  3. University College London, Gower Street, London, WC1E 6BT, UK

    Alexa Korb

  4. University College London Hospitals, 235 Euston Road, London, UK

    Edward Mawdsley

  5. Center for Medical Education in English, Poznan University of Medical Sciences, Poznan, Poland

    Jonathan Suresh

  6. Sir Alexander Fleming Building, Imperial College Rd, London, SW7 2DD, UK

    Joshua Xu

  7. Sir Alexander Fleming Building, Imperial College Rd, London, SW7 2DD, UK

    Piyush Koorapaty

  8. Kellogg College, University of Oxford, Oxford, UK

    Ankur Khajuria

  9. Department of Surgery and Cancer, Imperial College London, London, UK

    Ankur Khajuria

Authors
  1. Hatan Mortada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexa Korb
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Edward Mawdsley
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jonathan Suresh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joshua Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Piyush Koorapaty
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ankur Khajuria
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hatan Mortada.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Ethical Approval

Not applicable.

Human and Animal Rights

Not applicable due to the nature of the study.

Informed Consent

Not applicable due to the nature of the study.

Additional information

Publisher's Note

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

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mortada, H., Korb, A., Mawdsley, E. et al. The Use of Hyaluronic Acid in Non-surgical Rhinoplasty: A Systematic Review of Complications, Clinical, and Patient-Reported Outcomes. Aesth Plast Surg 48, 194–209 (2024). https://doi.org/10.1007/s00266-023-03386-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-023-03386-z

Keywords

Search

Navigation