The Ideal Nose In 5 Minutes Without Surgery: A Doctor Tells All

Are you self-conscious of your nose that you wish it could be a little taller and more defined or have a hump on your nose that you wish to flatten? Have you ever considered improving the shape of your nose but do not want to go through surgery? You are not alone.

As Asians, we tend to have a flatter nose bridge and a wider (bulbous) nose tip compared to our Caucasian counterparts. This causes the middle face to lack definition and ideal proportion. Therefore, nose and chin enhancements in Asia are commonly sought-after aesthetic treatments for better mid-face projection to establish facial harmony.

With non-surgical rhinoplasty aka nose job, you now can enhance your appearance through nose filler and threadlift, without the significant cost and risks associated with surgery.

Non-surgical rhinoplasty is one of my favourite procedures to perform as patient satisfaction is immediate with low to no downtime.

In this article, I will explain the difference between nose filler and threadlift and how I maximise the benefits of both procedures while overcoming their disadvantages using a combination approach for my patients.

 

Nose Filler

In nose augmentation, fillers are used for nose bridge and tip projections and flattening of humps (Figure 1 & 2) through precise volumisation.

 

When using filler for nose augmentation, the most important factor that will determine a good projection and satisfactory result is the rheology¹ of the filler. Both rheological properties of high G prime and cohesivity are critical for the best possible nose projection. The other important consideration is the longevity of the filler.

For hyaluronic acid (HA) fillers, Belotero Intense and Restylane Lyft (formerly Perlane) give excellent projection of the nose as they have one of the highest G prime and cohesivity amongst all HA fillers.

For semi-permanent collagen stimulators, calcium hydroxyapatite aka Radiesse and polycaprolactone aka Ellanse both give more projection per volume of product as compared to HA fillers. However, the downside is that they are not dissolvable. Hence it is important for an experienced injector to perform collagen stimulators especially for nose augmentation where a slight over-volumisation can result in an unnatural looking nose or bumps and lumps which are irreversible. The other advantage of collagen stimulators is that they tend to last longer, between 18 to 24 months compared to the above-mentioned HA fillers that last between 6 to 9 months.

In my practice, I use a wide array of fillers as each of them has different unique properties to cater to my patients’ individual needs.

 

Nose Threadlift

Most nose threads contain barbs or cogs that lift the soft tissue when inserted in the correct soft tissue plane. Threads are inserted through a single-entry point made via a needle at the tip of the nose in between the nostrils, for both nose bridge and tip definition and contouring (Figure 3). Threads also have a collagen stimulating effect and therefore can lead to further lifting effects over time.

In nose augmentation, it is preferable to use threads that are thicker and have sufficient barbs or cogs so as to give the most significant result with least number of threads needed. Lesser threads inserted and more barbs or cogs per thread to provide proper anchoring of soft tissue will reduce the chance of thread extrusion and migration that can lead to infection.

In addition to the type of nose thread used, the injector’s expertise is also key. Threads have to be placed in the correct soft tissue plane in order to get significant and natural looking results without the problems of thread migration and extrusion. Further, any slight deviation in the angle that does not follow the direction of the nose bridge during thread insertion can result in a slanted nose.

 

Nose Filler Versus Threadlift

This table provides a succinct comparison of both procedures:

	Pros	Cons
Nose filler	a)    Best for projection of nose bridge height and tip b)    Able to correct humps to smoothen out nose bridge c)     HA fillers are dissolvable d)    In experienced hands, fillers can be injected and moulded to achieve natural, beautiful results	a)     HA fillers can broaden the nose bridge, especially when using a filler with an unsuitable rheology b)     Collagen stimulators are irreversible c)     Unnatural results can occur in inexperienced hands d)     Risks of blindness and skin necrosis in inexperienced hands
Nose threadlift	a)     Best for creating definition and contouring of nose bridge and tip b)     Does not cause broadening of the nose bridge c)     No risk of blindness and skin necrosis	a)     Cannot correct humps b)     May have a limitation in improving the height of the nose bridge c)     Risks of thread migration, extrusion and infection in inexperienced hands

In summary, fillers are better for nose projection and correction of any humps through volumisation. Although low, the risks of vascular compromise causing blindness and skin necrosis are significant adverse outcomes that can be avoided in experienced hands. In addition, techniques such as using a blunt cannula instead of a sharp needle when performing nose filler helps to prevent inadvertent intravascular injection.² With a cannula the blood vessels are pushed out of the way because the tip of the cannula is blunt and harder for it to penetrate into the blood vessels. Injecting small amounts of filler slowly also helps to reduce vascular risks.³

On the other hand, threadlifts are better for providing definition and contouring of the nose bridge and tip. However, thread migration, extrusion and infection are risks that can occur. As with filler volume, more threads placed will increase the occurrence of risks due to the limited space in the soft tissue of the nose.

 

My Combination Approach

I often use a combination of both fillers and threadlift to obtain the best possible aesthetic result for my patient in the safest manner. This combination approach allows me to yield the strengths of both procedures while reducing the overall amount of filler and number of threads needed, thereby reducing the various risks involved with both procedures.

I perform this via a single-entry cannula approach. Firstly, local anesthesia is given to the tip of the nose which will allow painless entry with a needle followed by insertion of the cannula. I take extra measures to site the entry point slightly below the tip of the nose in between the nostrils so that it is not aesthetically obvious. Next, I inject the appropriate filler to provide volume to the nose bridge and the tip, providing projection and also evening out any humps which might be present. The nose is then molded to allow the fillers to set in place and to achieve a natural result. Using the same entry point, I then place threads to the nose bridge and tip to provide definition and contour.

This combined procedure can be done in a single session and takes between 5 to 10 minutes. The treatment is performed meticulously, checking the results from the front and side profiles as incremental amount of filler and number of threads are placed. Patient feedback throughout the procedure is also important to me, checking for any discomfort that might be felt and whether more projection and definition are desired.

 

Other Tips and Tricks for Refinement of The Nose

In the field of medical aesthetics, botulinum toxin is used to relax facial muscles. Specifically for the nose, it can relax the nasalis muscle that causes a wide nose tip and nasal flare.

Fillers placed in the canine fossa to improve the nasolabial fold (smile lines) can also cause a reduction in the nose tip by pushing it inwards. However, this procedure requires technical expertise to achieve the intended result in a safe manner.

 

Outcome

The intended result from non-surgical nose augmentation should be for patients to see an immediate improvement in projection and definition of their nose while minimising discomfort and downtime.

Patients often feedback that they can see their nose bridge better and that they do not have to use make up to contour their nose anymore. At the same time, it is a subtle enough difference that provides better facial harmony without a drastic change in shape.

 

Conclusion

In summary, non-surgical rhinoplasty using fillers and threads require both technical expertise and a keen aesthetic eye to consistently produce ideal results in a safe manner. An examination by and discussion with your doctor prior to embarking on this procedure allows for a shared decision of the treatment approach to obtain your desired results. Do not be afraid to ask questions and enquire for before and after pictures prior to embarking on any aesthetic procedure.

A successful enhancement of the nose is one that creates a natural 3-dimensional improvement that compliments the entire facial aesthetic profile. Family and friends will comment that you look prettier or more handsome but are unable to pinpoint exactly what has been done. That, to me and my patients, is the biggest compliment.

 

References

1. Pierre S, Liew S, Bernardin Basics of dermal filler rheology. Dermatol Surg. 2015 Apr;41 Suppl 1:S120-6.
2. Fulton J, Caperton C, Weinkle S, Dewandre L. Filler injections with the blunt-tip microcannula. J Drugs Dermatol. 2012;11:1098–103.
3. Sito G, Manzoni V, Sommariva R. Vascular Complications after Facial Filler Injection: A Literature Review and Meta-analysis. J Clin Aesthet Dermatol. 2019;12(6):E65–E72.

 

Written by Dr. David Deng,

MBBS, MRCS