Skin Necrosis of the Nose After Injection of Ribose Cross-Linked Porcine Atelocollagen

We report a case of skin necrosis of the nasal tip after an injection of ribose cross-linked porcine atelocollagen (Evolence; Colbar Life Science Ltd, Herzliya, Israel). A 22-year-old woman had a nasal augmentation. From the glabella to the nasal tip, 10 strokes were injected using 0.6 mL of Evolence. On the day of the injection, her nasal tip became cyanotic; a day after it, an erythematous condition developed and a white cheeselike material appeared. On the second day, it became necrotic. Epithelialization was completed for 2 weeks. Despite laser therapy, permanent scarring of the nasal tip was prominent at the 18-month follow-up. It was thought that the skin necrosis is caused by vascular interruption rather than by hypersensitivity because the skin necrosis was confined to the nasal tip. To avoid vascular interruption from a filler injection, aspiration is needed before injection. The least amount of filler should be released in each stroke with low-pressure injection.