Abstract
Aim and Background
The increasing use of filler rhinoplasty has led to more patients presenting with
complications such as fibrosis, granuloma formation, skin irregularities, and filler
migration, including the characteristic “Avatar nose.” These cases require a systematic,
algorithm-driven approach for safe and predictable correction.
Historical Aspects
Nonsurgical rhinoplasty has gained popularity due to its minimally invasive nature,
yet complications requiring surgery have become increasingly recognized.
Anatomy
Distorted soft-tissue planes and altered skin-soft-tissue envelopes (SSTE) after filler
placement influence both dissection and reconstruction.
Technology
High-frequency ultrasound can assist in identifying residual filler and guiding hyaluronidase
dissolution before surgery.
Patient Selection
Patients with persistent deformity, migration, granuloma, or long-standing fillers
unresponsive to nonsurgical measures are appropriate surgical candidates.
Techniques
Revision rhinoplasty involves open approaches, selective removal of residual filler,
and structural reconstruction with autologous cartilage. Redundant SSTE may require
increased dorsal augmentation, conservative trimming, and adjunctive intraoperative
doxycycline.
Postoperative Care
Postoperative corticosteroid injections can limit fibrosis and improve contour.
Current and Future Development
Algorithm-based evaluation and operative planning continue to refine management of
these complex cases.
Conclusion and Clinical Relevance
Thoughtful surgical execution is essential for achieving stable, natural outcomes
in patients with filler-related nasal complications.
Keywords
filler rhinoplasty - revision rhinoplasty - avatar nose - hyaluronidase
