Persistent HA Fillers and Nasal Broadening: Role of Ultrasound in Managing "Avatar Nose"

BACKGROUND: Nonsurgical rhinoplasty with cross-linked hyaluronic acid (HA) fillers is popular for enhancing nasal esthetics, especially in Asian patients seeking dorsal augmentation. While fillers are expected to last 6 to 12 months, evidence shows they can persist for years, causing delayed complications like broad nasal bridges, termed "Avatar Nose." This case report describes 3 patients with this phenomenon and highlights the role of high-resolution ultrasound in diagnosis and management.

METHODS: From January to November 2024, 3 patients with broad nasal bridges following HA filler injections were identified. All underwent clinical evaluation and portable ultrasound imaging (Sonon 500L, Healcerion) to confirm residual HA. Ultrasound-guided hyaluronidase injections were performed to dissolve the filler. Follow-up assessments included ultrasound imaging and clinical photography to evaluate outcomes.

RESULTS: Patients presented with delayed broadening of the nasal bridge years after a single HA injection. Ultrasound confirmed residual HA and guided hyaluronidase injections significantly improved nasal contour, reducing the bone-to-skin thickness and resolving the broadened appearance. The procedure was well-tolerated, with minimal downtime and no adverse effects.

CONCLUSIONS: "Avatar Nose" underscores the importance of recognizing long-term HA filler complications. Ultrasound is critical for diagnosis and precise treatment. Ultrasound-guided hyaluronidase injection is an effective and minimally invasive solution, emphasizing the need for informed patient consent and further research into delayed filler effects.