PMC4298868_01
An amatory photo before HA injection shows normal nasal alar structures
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F1
A 54-years-old Iranian woman underwent injection of HA fillers into nasolabial folds for wrinkle correction of this region by an anaesthesiologist (Figure 1).
Right nasal alar partial necrosis, 3 weeks after HA injection to right nasolabial fold
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By the third day from the onset, blisters appeared at the right nasal ala (Figure 2).
Forty days after HA injection, the necrotic areas demarcated in alar region
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F3
Then a black area in the right nasal ala appeared which represent skin necrosis in this area, the necrotic areas well demarcated (Figure 3).
Two months after injury, the gross necrosis tissue sloughed and its bed inflamed and was fibrinous
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F4
With passing time and wound care the grossly necrosed part sloughed and the bed was tidy and inflamed (Figure 4).
Three months after injury, when she was visited by plastic surgeon, the bed of right nasal alar region and perinasal area were inflamed and fragile
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F5
She was advised to tolerate it up to improvement of the inflammation and wound maturation (Figure 5).
A (Left column): One year after injury and before reconstruction, B: (Right column) Three weeks after the reconstruction with composite graft from the right auricular helical root which showed excellent take
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F6
After one year and subsidence of skin inflammation and irritation, a composite graft taken from the helical root of her right auricule was grafted to the residual skin defect (Figure 6).