NASAL CUTANEOUS ISCHEMIA SECONDARY TO HYALURONIC ACID FILLER

Abstract

DOI: https://doi.org/10.46296/yc.v10i19.0944

Abstract

Background: Hyaluronic acid (HA) fillers are widely used in minimally invasive aesthetic procedures. Nasal cutaneous ischemia after filler-related vascular occlusion is uncommon but potentially devastating because it may progress to necrosis, scarring, and ophthalmic complications. Available evidence is dominated by case reports and case series with heterogeneous rescue protocols. Objective: To synthesize the available evidence on presentation, treatment, and outcomes of nasal cutaneous ischemia secondary to HA filler, perform an exploratory meta-analysis of favorable cutaneous outcome, and contextualize an illustrative clinical case. Methods: A structured review was conducted following PRISMA 2020 principles. PubMed/MEDLINE was searched from inception through August 5, 2026, supplemented by backward and forward citation tracking. Case reports, case series, and cohorts describing nasal cutaneous ischemia/necrosis after HA filler were eligible. Individual cases were summarized narratively. Quantitative pooling was restricted to multi-patient nasal cohorts with harmonizable final outcomes. Random-effects DerSimonian-Laird meta-analysis was performed on the logit scale. Results: Fifteen clinically relevant reports/series representing approximately 48 patients were included in the narrative synthesis. Only two cohorts provided harmonizable outcome data (21 favorable outcomes among 29 patients). The pooled favorable cutaneous outcome was 73.9% (95% CI 43.6%-91.2%; I²=36.9%). This estimate is exploratory and of very low certainty because only two cohorts contributed and most evidence was uncontrolled. Across the broader literature, earlier recognition and hyaluronidase-based rescue were consistently associated with better outcomes, whereas evidence for adjunctive therapies remained heterogeneous. Case: A 35-year-old woman with no relevant history and normal vital signs developed nasal skin changes after HA filler injection. The supplied image demonstrates an erythematous-violaceous area over the nasal dorsum/lateral wall in keeping with impaired perfusion in the reported context. Conclusions: HA filler-related nasal cutaneous ischemia is a time-sensitive emergency. Early recognition and prompt hyaluronidase-mediated degradation of HA are the most consistently supported interventions. Prospective registries and standardized outcome definitions are needed.

Keywords: hyaluronic acid; dermal fillers; nose; vascular occlusion; skin ischemia; necrosis; hyaluronidase; meta-analysis; case report.