Whereas the injection of fillers is a relatively safe procedure, adverse events (AEs), including serious ones like vascular compromise and ischemic complications, do occur. Complications from filler injection can occur anywhere on the face, but the nose poses a higher risk than anywhere else. The continuing rise in popularity of non-surgical rhinoplasty (NSR) demands that injectors develop a firm understanding of needed safety precautions so that outcomes are not only elegant and beautiful but also safe.
Injection safety in the nose hinges primarily on preventing and managing ischemic complications. Although bruising, erythema, tenderness, and swelling may occur, these are transient and treatable with over-the-counter medication and vascular lasers. In addition, moderately serious AEs like granuloma and delayed onset nodule formation that occur with filler injection in other areas of the face have not been reported after using US FDA-approved fillers in the nose.
Overall, the principles that govern safe injection in the face can be applied to ensure safety in NSR; however, following those principles meticulously is of paramount importance with nasal injections. The nose is the most dangerous area in the body to inject with filler, and complications can be catastrophic.
There are numerous reviews and reports of filler-related blindness and tissue necrosis, which illustrate this point all too well. Injectable filler vascular complications happen when the tip of the needle or cannula is inside an artery, and a large amount of material is injected under high pressure, obstructing critical blood supply to the skin or the eye. The only exception to this rule is in the tip of the nose or the alar area, where ischemia can occur because too much filler compresses the small vessels in a tight space, causing a compartment syndrome-like effect.
Preventing complications, therefore, hinges on preventing the confluence of these factors.