Management of Ischemia and Necrosis Following Nonsurgical Rhinoplasty With Hyaluronic Acid: A Case Report

TL;DR

A patient developed nasal tip ischemia and necrosis after a nonsurgical rhinoplasty with hyaluronic acid, and was successfully treated with a combination of therapies including hyaluronidase.

Contribution

This case report presents a successful multimodal treatment approach for severe complications following nonsurgical rhinoplasty.

Findings

Treatment with hyaluronidase and other modalities led to regression of ischemia within one day.

Complete re-epithelialization occurred within 26 days of treatment initiation.

Multimodal management minimized sequelae and favored wound healing.

Abstract

Nonsurgical rhinoplasty with hyaluronic acid (HA) is minimally invasive but may result in severe vascular complications such as ischemia and necrosis. This case report describes a 30-year-old female patient who developed ischemia and early necrosis of the nasal tip after HA injection. Treatment was initiated approximately 72 hours after the injection, and management included multipoint hyaluronidase, massage and warm compresses, low-level red laser therapy, systemic antibiotic and corticosteroid administration, in addition to hyperbaric oxygen therapy and photodynamic therapy. Regression of ischemia was observed on the first day after treatment initiation, and complete re-epithelialization occurred within 26 days. Early diagnosis and multimodal management centered on hyaluronidase favored ischemia reversal and wound healing, minimizing sequelae.

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