Livedo Reticularis of the Nose Following HA Filler Injection

Hyaluronic Acid (HA) fillers have gained significant popularity as a non surgical technique to augment soft tissues.HA injections to the nose have become increasingly common to reshape the nose, address minor imperfections and correct asymmetries.While generally considered safe, HA injection to the nasal region can be associated with potentially severe complications.A case of a 37-year-old woman who had undergone two prior open rhinoplasty procedures received intranasal HA filler.Within 12 hours, she developed a mottled net-like pattern on the nasal tip and dorsal skin recognized immediately as Livedo Reticularis (LR).Prompt treatment with pulsed high dose hyaluronidase, low dose salicylic acid, transdermal nitropatch and warm compresses were able to achieve complete resolution of this complication.LR results from the disruption of local cutaneous circulation.In the case of HA fillers, it is thought to occur when injected filler obstructs the local vasculature.If left untreated, LR can progress to soft tissue ischemia and ultimately necrosis.We present this report to highlight the importance of prompt recognition and treatment of this vascular insult, particularly in the post rhinoplasty patient, in order to avoid potentially significant skin necrosis, scarring, wound care and surgical reconstruction.