Hyaluronidase injection vs direct surgery in surgical rhinoplasty patients treated with non-surgical nasal reshaping with hyaluronic acid filler: a systematic review

Background Non-surgical nasal reshaping with hyaluronic acid filler is a well-established procedure performed in order to ameliorate nasal appearance and considered a valid alternative to surgical rhinoplasty in selected patients. The aim of this systematic review is to evaluate, in patients looking for surgical rhinoplasty who already received nSNR with HA, if hyaluronidase injection before surgery is to prefer instead of direct surgery in order to reduce/avoid intra-operative troubles in performing a rhinoplasty. Methods The literature search was carried out on electronic PubMed and Cochrane Library databases identifying 567 articles up to May 19th, 2021. Number of patients, outcomes and complications were extracted. Results Three retrospective articles were eligible for inclusion in the review. Thirteen patients were operated on for rhinoplasty who previously received nSNR with HA. Six received hyaluronidase injections before surgery and 7 underwent directly to surgery. Among the 7 who went straight to surgery, in 5 of them, 6 months was the specified time lapse between last HA injection and surgery. Among the ones receiving hyaluronidase injection before surgery, the time lapse reported was 6 months for 1 patient, 3 months for 2 patients, 2 months for 1 patient and 7 days for 1 patient. Post-operative complications were not recorded. Conclusions Either direct surgical approach or hyaluronidase injection first seems to be a viable option with the total absence of post-operative complications. When direct surgery is preferred, it could be demanding and customized informed consent should be released to the patients prior to surgery. Level of evidence: Not gradable.