Rhinoplasty in patients with prior nasal fillers: A prospective cohort study on the surgical management of the "filled nose".

[BACKGROUND] The rising use of nasal dermal fillers has introduced challenges for patients undergoing subsequent rhinoplasty. Prior injections can cause fibrosis, anatomical distortion, and altered vascular patterns, complicating surgical dissection and reconstruction.

[PURPOSE] To evaluate the safety, intraoperative features, and functional and aesthetic outcomes of a structured, image-guided surgical protocol for rhinoplasty in patients with prior nasal filler injections.

[METHODS] This single-center prospective cohort study included 48 patients undergoing primary or revision rhinoplasty after nasal filler treatment, with 24-month follow-up. Preoperative assessment included high-resolution ultrasound in all cases and magnetic resonance imaging in complex cases. Intraoperative findings, filler characteristics, graft requirements, and complications were systematically recorded. Functional outcomes were measured using the Nasal Obstruction Symptom Evaluation (NOSE) scale, and aesthetic outcomes were evaluated with the Rhinoplasty Outcome Evaluation (ROE) scale and standardized photography.

[RESULTS] Filler remnants were identified intraoperatively in 85.4% of patients, with dense fibrosis in 91.7%. Complete filler removal was achieved in 70.8% of cases, and structural grafting was required in 66.7%. Mean NOSE scores improved from 56.3 preoperatively to 18.7 at 12 months (p < 0.001), and mean ROE scores increased from 42.8 to 85.1 (p < 0.001). Overall patient satisfaction was 89.5%, with an 8.3% total complication rate and no major vascular events.

[CONCLUSION] Rhinoplasty after nasal fillers presents significant anatomical and technical challenges. A structured, image-assisted surgical protocol supports safe management, functional improvement, and favorable aesthetic outcomes. Further controlled, multicenter studies are warranted to validate these results and distinguish filler- versus surgery-related effects.