Necrosis in nose tip? (Photo)

Question

Hello, I had filler injected to my nose 4 days ago. The area where the filler was injected is a little red, but I don't have any pain or swelling. Do you believe that this might turn to necrosis? I asked the nurse who injected me, and she said if it turns black go to the hospital. Which is a very bad answer since it would be to late if I wait untill then. I would rather do something about it now if there is any chance this will lead to necrosis.

Christopher C. Chang, MD · Answer

Thank you for your question.

Necrosis after filler is rare, but is possible depending on the circumstances.  In this area the circulation is usually quite good and the risk for necrosis is low.  However, you are right, once it turns black, it's too late.

I would go back to the doctor who did the injection and ask for advice- it is difficult to assess this through a single picture.  Also, taking photos of it every day will allow you to see how it changes (take them from the same angle and at the same time of day) so that you can objectively tell if it's getting worse before necrosis does begin.Overall, as I said, necrosis is rare and I would think this is more likely a little bit of bruising and/or inflammatory response causing redness.

The risk factors that would make me MORE concerned for necrosis would be:

1.  prior nasal surgery (rhinoplasty)

2.  history of infection, healing problems

3.  large volume of filler in a small space

4.  If it was very white and then turned purple and black a few days later

5.  medical problems that make healing more difficult

6.  trauma to the nose

7.  Use of steroids, medications, or nasal sprays (or illicit drugs) that cause restricted blood flow in the nose.

Hope that helps.

Eric M. Joseph, MD · Answer

With necrosis after HA, there is typically a lot of pain in discomfort. And things get worse, not better, over 4 days. I hope this helps. Sincerely, Dr Joseph

Asif Pirani, MD, FRCS(C) · Answer

If someone os concerned about an intra-vascular event after fillers, an in-person consultation is usually best.The foregoing information provided is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. You assume full responsibility for how you choose to use this information. Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition.

Shanthala Shivananjappa, MD · Answer

Vascular anatomy of the nose is very complex, it has an extensive set of blood supply from branches of both external and internal carotid artery. The risk of accidental vascular occlusion resulting in blindness and skin necrosis is very high with nasal fillers especially in the tip of the nose compared to fillers in other areas. Some times necrosis may not be accompanied by pain and swelling at the time of injection, and delayed compression of vessels by product was proposed mechanism.

It is very difficult to make a diagnosis by looking at your photo. See an experienced cosmetic physician/surgeon as early as possible if you have any doubts.

Best Wishes. Dr. Shanthala

It is very difficult to make a diagnosis by looking at your photo. See an experienced cosmetic physician/surgeon as early as possible if you have any doubts.

Best Wishes. Dr. Shanthala

Hardik Soni, MD · Answer

It is difficult to assess your injury to your nose from photos. Necrosis can be very painful. It is the result of complete loss of circulation to an area. It develops within hours to a day, it is not a delayed reaction. I advise you to have this evaluated by your treating physician and discuss your concerns.

Pamela Stuart, MD · Answer

I'm sorry for the inadequate response you were given by the nurse for your concerns. It is difficult from your photo to determine what the extent of the discoloration entails. However if you have concerns regarding injury to the treated area, you need get in and have this evaluated by the physician at the site where you were treated as soon as possible.

Lisa Vuich, MD · Answer

The photo you provide does not appear to show necrosis. Necrosis is quite painful as it is the result of complete loss of circulation to an area. It develops fairly quickly (within hours to a day), it is not a delayed reaction. The immediate response to threatened vascular flow in the setting of dermal filler involves- administering aspirin, topical nitrates, injecting the region with hyaluronidase, warm packs, manual massage and the immediate involvement of a plastic surgeon. I would not hang out in an E.R. waiting room, and they rarely have the hyaluronidase on hand unfortunately. It has a short shelf life (expiration date) and is fortunately rarely needed.

Best,

Lisa Vuich, MD

Best,

Lisa Vuich, MD

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