Advances of Hyaluronic Acid Nasal Injection Techniques and Complications: A Systematic Review.

[BACKGROUND] The increased demand for non-surgical rhinoplasty using hyaluronic acid (HA) has given impetus to explore more injection techniques and has also placed a higher demand on the coping of complications.

[OBJECTIVES] The purpose of this systematic review is to provide clinicians with recommendations by broadly consolidating data on HA injections for rhinoplasty injection techniques and complications, and presenting the advantages and disadvantages of each technique and the treatment of complications.

[METHODS] A systematic electronic literature search using keywords and MESH search terms over the PubMed/Medline, Cochrane Central, Embase, Web of Science, and CNKI online databases was conducted from 2000 to 2024. Risk of bias assessment was performed for all included articles.

[RESULTS] There were 37 papers with a total of 7339 patients included in the study. Four different injection regimens were summarized. The incidence of serious complications such as blindness, skin necrosis, and cerebral infarction was only 3‰. Mild complications including bruising, hematoma, edema, and asymmetry had a higher incidence of 13.34%.

[CONCLUSION] Existing techniques for hyaluronic acid nasal injections can be summarized as top-to-bottom approach, bottom-up approach, critical site injections, and multi-plane injections, with the latter two more innovative injections reporting higher complication rates in comparison.

[LEVEL OF EVIDENCE I] 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   www.springer.com/00266.