Use of injectables in rhinoplasty retouching: Towards an evolution of surgical strategy? Literature review.

[BACKGROUND] Surgical revision rate of rhinoplasty is from 5% to 15% in literature.

[OBJECTIVE OF REVIEW] In the context of post-rhinoplasty deformities, we aim to investigate the modalities of using injectables, their impacts on revision rate of rhinoplasty as well as their influences on the surgical strategy.

[TYPE OF REVIEW] We realized an international literature review to collect informations on main studies reporting series of exclusive secondary medical rhinoplasties or mixed primary/secondary medical rhinoplasties, as well as per-operative injection.

[SEARCH STRATEGY] The databases of the National Library of Medicine, Cochrane Library, Embase and Web of science were explored using the following Boolean string: (rhinoplasty OR nose) AND (injectable OR fillers OR hyaluronic acid OR calcium hydroxylapatite). The search was limited to the English language literature for studies published from 2007 up to December 2019.

[RESULTS] Fifteen cohort studies were included. Hyaluronic acid was the most commonly used injectable for rhinoplasty revision. Patient satisfaction rates varied between 80% and 100%. Reinjections were necessary in about 20 to 50% of cases whatever the used injectables. Minor complications (swelling, bruising, erythema) were frequent after filler injections (4%). Severe complications such granulomas or vascular embolism causing skin necrosis/visual impairment were rare (0.4%). Their physiopathology, management and prevention are detailed.

[CONCLUSIONS] The use of injectables seems to reduce the need of secondary surgical rhinoplasties. It can be expected that an evolution in surgical practices will result from injectables using, but it will be possible only if the technique is perfectly understood to avoid potentially serious vascular complications.