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In general, injections of filler can be safe when performed properly. However, there have been reports of loss of skin due to interference of blood flow when the filler goes into the tiny (more)

In general, injections of filler can be safe when performed properly. However, there have been reports of loss of skin due to interference of blood flow when the filler goes into the tiny vessels of the nose.
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Many years ago Zyplast a more robust form of bovine collagen caused arterial embolization
with subsequent tissue necrosis. The most come site was the frown(56%) because of the paucity (more)

Many years ago Zyplast a more robust form of bovine collagen caused arterial embolization
with subsequent tissue necrosis. The most come site was the frown(56%) because of the paucity of a large midline blood supply. Embolization has been noted on histologic examination to support this as a mechanism. This also was know to occur in acne scars(lack of blood supply). To this day a famous male actor has a scar on his right cheek from this !!! Also the lip, nasolabial folds and nose were sites of occurrence. While the reported incidence was 9/10,000 its true rate of occurrence probably was much higher in that most reactions were never reported. Necrosis has been seen with HA?(Hyaluronic injectables) and its occurrence is is preceded by a blanch which would suggest a similar mechanism though some suggest a pressure phenomena. This is when hyaluronidase such immediately be employed. I have also seen it with Sculptra,Radiesse and silicone.It is very critical to be cautious In a nose that has had a previous rhinoplasty(s) in that the blood supply is already compromised. In either situation I would suggest a 32 gauge needle with Restylane.for injection. Complications related to interrupted blood supply to the nose can also occur with nasolabial fold dermal injection with HA's and other fillers .The exact mechanism of this event is unknown though it is thought that once injected an HA will expand putting pressure on the facial artery. With blanching nitropaste together with hualuronidase is suggested. (less)