Study Design: Systematic review of hyaluronic acid (HA)-related complications. Objective: To systematically review all available literature including case reports and case series to identify a pattern for the management of vascular compromise resulting in facial skin ischemia and ocular manifestations following HA injection. Methods: This review was based on a systematic search of 3 electronic databases PubMed, CINAHL, and Scopus for all available literature including case series and case reports from database inception to July 2019. Only a total of 52 case reports/series were eligible for review and included 107 patients. Results: The reviewed literature available was comprised from case reports/series and indicated that management of both impending skin necrosis and visual disturbances is variable with no repetitive pattern of action. Yet, successful management is time dependent as early interventions stopped progression and, in some cases, even reversed adverse effects. Conclusion: Results found no universal protocol for achieving optimal results for adverse effects and as such, we present a step-by-step algorithm for the emergency management of complications following HA injection.

Summary: Ear protrusion is the primary indication for otoplasty. Many methods have been developed for addressing this defect, based on cartilage-scoring and excision and suture-fixation techniques. Disadvantages include irreversible distortion of the anatomy, irregularities, or overcorrection, or forward bulging of the conchal bowl. One of the most common long-term sequelae of otoplasty is an unsatisfactory result. A novel, cartilage-sparing, suture-based technique has been developed that aims to minimize the risk of complications and provide a natural-appearing aesthetic result. The method is based on two to three key sutures that shape the concha into the desired natural appearance while preventing a conchal bulge, which otherwise could appear if no cartilage is removed. Furthermore, these sutures support the neo-antihelix created by four further sutures anchored to the mastoid fascia, thus achieving the two main goals of otoplasty. The sparing of cartilaginous tissue means that the procedure is reversible if needed. In addition, permanent postoperative stigmata, pathologic scarring, and anatomical deformity can be avoided. This technique was used on 91 ears in 2020 and 2021, with only one ear (1.1%) requiring revision. Rates of complications or recurrence were low. The presented technique appears to be a rapid and safe method for treating the prominent ear deformity, providing aesthetically pleasing results.