Soft tissue reconstruction of the nose.

Soft tissue repair of skin defects of the nose-being in the middle of the face-is very demanding with regard to its functional and aesthetic outcome to allow successful rehabilitation of the patient concerned. In the majority of these cases, soft tissue reconstruction using local and regional flaps is indicated after individual therapy planning considering location and size of the defect, the patient's age, and his or her wishes. Flaps from nasal skin, glabella, forehead, as well as nasolabial fold provide good possibilities to cover the defect externally and ensure matching color and texture. Full-thickness skin grafts and healing by secondary intent are second-choice therapies. In the case of partial amputation of the nose, a nasolabial rotation flap can be used for inner lining, if necessary supported by septal cartilage or a composite graft building a stable nasal scaffold from the inside for the outside. The possibilities of facial plastic surgery, the exact knowledge of vascular supply, and flaps adjusted to individual requirements allow achievement of an outcome that is aesthetically and functionally satisfying for the patient.

Hyaluronic Acid-based Filler Injection: Late-onset Thrombosis of the Frontal Vein.

Thrombosis is a serious complication of a hyaluronic acid-based filler injection. Little is known about the late-onset complications of fillers; therefore, an optimal complication management is necessary. In this case report, we describe a rare complication of thrombosis after a filler injection. A 35-year old woman was admitted to the emergency department, with swelling on her forehead in association with recurrent pain and light flashes in her right eye. Sonographic examination showed a thrombosis of the right frontal vein. The patient reported that a hyaluronic acid filler injection had been administered on the forehead 3 months ago. After several weeks of anticoagulation with heparin and apixaban, the symptoms persisted. The vein with thrombosis was ultimately resected under local anesthesia. Histological findings showed a chronic inflammatory reaction of the tissue to hyaluronic acid. Vascular complications may appear as late-onset complications even several months after the filler injection. Subcutaneous application of low molecular weight heparins is the therapy of first choice. If this treatment is not effective, resection of the thrombosis may be performed.