Ultrasound Examination is Mandatory in the Diagnosis and Treatment of Complications from Filler Injection: A Case Report

We present the case of a 45-year-old female patient who developed redness of the nasal tip without other signs or symptoms the day after rhinofiller treatment. The injector performed various treatments to address this unwanted effect, but with no significant improvement. Initially, he prescribed Brimonidine gel 3 mg/g, which has vasoconstrictive action. Then, bromelain, administered orally once a day, was added to the previous treatment. Lastly, topical hyaluronidase was applied to the tip of the nose every 4 days to 5 days for a month. After 15 weeks, a consultation at our center to treat complications was requested. An ultrasound examination revealed an HA accumulation on the nasal tip compressing the dorsal nasal arteries. This was immediately treated with an ultrasound-guided injection of hyaluronidase (15 I.U.) directly into the HA accumulation. The redness began to fade the following day and was completely gone within 5 days without any other treatment. In conclusion, we highlight the role of ultrasound examination in diagnosing complications from filler injection. This examination should be performed immediately when a complication appears, without delay in pursuing alternative treatments. Ultrasound examination is also essential in treating filler complications, allowing visualization of filler accumulation and guiding the direct injection of a minimal amount of hyaluronidase into it.