Undissolved residual nasal filler and wide alae: causes, removal, and correction methods

Hello, I am Medical Director Dr. Peter C. Kang.

Today, I would like to share a case of a patient who struggled with undissolved filler issues and sought bulbous nose correction.

• 5 years ago: HA filler injection

• 1 year ago: Hyaluronidase injection received, but diagnosed as not completely dissolved

• 5 months ago: Fat-dissolving injection targeting the alar cartilage area

Functional concerns:

• Difficulty breathing

Aesthetic concerns:

• Crooked nose

• Bulbous nose (large alae)

• HA filler from 5 years ago not fully absorbed

• Nose appears wide due to large lower lateral cartilages

• Improvement in breathing

• Crooked nose correction

• Bulbous nose correction (reduction of alar size)

Foreign material removal:

• Complete removal of unabsorbed HA filler

Structural improvements:

• Rhinoplasty using autologous rib cartilage

• Crooked nose correction

• Bulbous nose correction via lower lateral cartilage trimming

Functional improvement:

• Breathing improvement through septoplasty and radiofrequency inferior turbinate submucosal resection

Front view:

• Crooked nose correction

• Refined nasal contour through bulbous nose correction

• Natural alar size

Profile view:

• Balanced nasal line

• Natural profile contour

Alae:

• Alae adjusted to an appropriate size

• Natural alar shape

• Overall refined impression

Functional improvement:

• Restoration of smooth breathing function

This case involved resolving both the aftereffects of multiple previous procedures and a congenital bulbous nose. The patient had received HA filler 5 years ago, but over time it remained without being completely absorbed. 1 year ago, the patient even received a filler-dissolving injection, yet was diagnosed with residual filler that was still not completely removed.

HA (hyaluronic acid) filler is a representative absorbable filler that generally biodegrades naturally in the body within 6 months to 1 year. However, depending on individual tissue characteristics, the type of filler, and the depth of injection, it can sometimes persist longer than expected. Over time, it can integrate with surrounding tissue, making natural absorption or removal with dissolving injections difficult, which necessitated complete surgical removal in this operation.

Furthermore, the patient had received an injection 5 months prior intended to dissolve fat around the alar cartilage. This is a medically unproven procedure that can pose risks. It is impossible to dissolve the lower lateral cartilage itself, and such attempts can instead cause tissue damage, requiring caution.

The patient's main concern was a bulbous nose with wide alae. During surgery, examination confirmed that the lower lateral cartilages were indeed large and widely developed, causing the nose to appear broad overall. Because this was a congenital anatomical feature, lower lateral cartilage trimming was necessary for a fundamental solution.

First, the unabsorbed HA filler was completely removed to achieve a clean tissue bed. Next, the crooked nose was corrected, followed by the crucial trimming of the lower lateral cartilages. By precisely refining the excessive portions of the lower lateral cartilages, the nasal width was reduced, establishing a refined alar shape.

Trimming the lower lateral cartilage is a procedure requiring meticulous technique; excessive resection can lead to alar collapse or an unnatural appearance. It was essential to remove only an appropriate amount while taking into account the patient's facial proportions and overall nasal harmony.

To improve breathing issues simultaneously, septoplasty and radiofrequency inferior turbinate submucosal resection were performed in combination. This addressed the functional problems as well.

Ultimately, the unabsorbed HA filler was completely removed, and the large lower lateral cartilages were appropriately trimmed to naturally correct the bulbous nose. The crooked nose was also improved, creating a balanced and refined nasal shape in this successful outcome.

In particular, by trimming the lower lateral cartilages, the patient's primary concern—the bulbous nose—was fundamentally addressed, yielding a satisfying result.

All procedures are performed using a closed approach.

This has been Dr. Peter C. Kang, medical director.

Thank you.

#closedrhinoplasty #fillerremoval #bulbousnosecorrection #alarcartilagetrimming #crookednosecorrection #customrhinoplasty

This is an informational notice regarding postoperative instructions and potential side effects provided to patients. It outlines general complications such as infection, bleeding, asymmetry, scarring, and skin necrosis.