Five-point liquid rhinoplasty: Results from a retrospective analysis of a novel standardized technique and considerations on safety

Nonsurgical Rhinoplasty: Results from a Retrospective Study of Rino-4-Puntos Technique with Hyaluronic Acid

BACKGROUND

Nonsurgical rhinoplasty (NSR) utilizing hyaluronic acid (HA) filler injections is increasingly used to address nose shape issues. While refinements have been proposed, the technique lacks standardization.

OBJECTIVES

Our study aimed to evaluate the aesthetic outcome, longevity of results, safety, and patient satisfaction with the novel Rino-4-Puntos (R4P) NSR technique.

METHODS

This is a retrospective study of consecutive individuals treated with R4P between January 2021 and July 2023. All participants had one of the four indications: rectification of the dorsum (21%), triangulation of the tip (32%), projection (25%), and strengthening of the columella (22%). Each patient received two hyaluronic acid (HA) fillers: one with intermediate G prime (G') at Points 1-3 and another with high G' at Point 4, which is further divided into Points 4.1, 4.2, 4.3, and 4.4. The injection points were as follows: P1 (radix, 0.05-0.15 mL, supraperiosteal), P2 (supratip, 0.025 mL, suprachondrial), P3 (tip, 0.15 mL, deep fat), P4 (columella, 0.30 mL, supraperiosteal [4.1], or deep fat [4.2, 4.3, and 4.4]).

RESULTS

Four hundred individuals (n = 284 [71%] females) are included. The mean filler volume used was 0.65 ± 0.17 mL. Injecting small boluses (≤ 0.05 mL) in the midline at deep planes minimized the risk of adverse effects, as no vascular complications occurred. Ninety-three percent of participants considered the overall outcome at least satisfactory ("good," "very good," or "excellent"). The treatment effect was maintained for a median of 11 months.

CONCLUSIONS

The R4P technique refines NSR by combining enhanced aesthetic outcome, longevity, and safety.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Nonsurgical Rhinoplasty in Patients of African Descent: A Retrospective Review

BACKGROUND

There is a paucity of research on nonsurgical rhinoplasty in the population of African descent. In this group, underlying anatomy and aesthetic ideals vary, necessitating differences in the consultation process and in treatment. The authors present a case series from a single clinician's practice performing nonsurgical rhinoplasty on patients of African descent.

METHODS

A retrospective chart review was completed on eligible patients who underwent nonsurgical rhinoplasty treatment with hyaluronic acid filler injections performed by the first author (A.H.) from March of 2018 to February of 2021. Demographic variables, indications for treatment, patient-reported outcomes, and adverse events were reviewed. The authors also share the first author's technique for nonsurgical rhinoplasty in this patient cohort.

RESULTS

A total of 487 patients of African descent or mixed race including African descent were included in this study. The most common indications for treatment were lack of bridge definition (63.9%), excessive alar width (61.6%), and a bulbous tip (61.6%). Median filler volume was 0.6 mL (range, 0.3 to 2.1 mL) at the initial treatment visit. There were no reported cases of infection, vascular occlusion, or necrosis.

CONCLUSIONS

This study is the first to illustrate the effectiveness and safety profile of nonsurgical rhinoplasty in a population of African descent. Anatomical variations and the desire for racially congruent results must be acknowledged to ensure satisfactory outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Ellansé: Advanced Technology and Advantageous Selection of New Collagen Stimulating Agents for Face Rejuvenation

Facial injections have a comparative mature market and system in China, but all kinds of injection materials have their own advantages and disadvantages, even hyaluronic acid, as the most common injection material, can form an unnatural stiffness after injection. Currently, Ellansé, a biodegradable collagen stimulator, has shown superior aesthetic results while ensuring safety and naturalness, making it a more preferable choice for a variety of facial injections. The purpose of this review is to introduce the features and benefits of Ellansé, so that doctors in the field can better understand and learn how to use it properly and minimize the risk of complications, and have a better choice for the medical aesthetic field in China in numerous aspects. The papers with the keyword "Ellansé" is very few in number, and there is a lack of systematic overview. Ellansé itself has unique advantages for the Chinese population, as it is an attractive option for the treatment of aging face due to high patient satisfaction, long-lasting results and low side effects (Guo et al. in J Cosmet Dermatol 21(5):1959-1966, 2022). More clinical data will be available in the future to confirm its performance and longevity in various sites. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Nonsurgical Rhinoplasty with Hyaluronic Acid

The history of nonsurgical rhinoplasty with hyaluronic acid fillers dates back to the early 2000s when medical advancements in cosmetic dermatology began exploring less-invasive alternatives to traditional surgical procedures. Hyaluronic acid, a naturally occurring substance in the body known for its hydrating and volumizing properties, was being used successfully in other facial augmentation treatments. Around the mid-2000s, the use of hyaluronic acid fillers for nonsurgical rhinoplasty gained momentum. By injecting hyaluronic acid fillers into precise areas of the nose, cosmetic practitioners could effectively smooth out irregularities, correct minor asymmetry, augment the nasal bridge and even enhances nasal tip projection and definition.

Nonsurgical rhinoplasty using the hyaluronic acid filler VYC-25L: Safety and patient satisfaction in a retrospective analysis of 492 patients

BACKGROUND

Aesthetic treatment of the nose with hyaluronic acid (HA) fillers is increasingly popular but carries a small risk of major complications. Large patient cohorts are required to better understand this risk.

AIMS

To evaluate safety and patient satisfaction in a large series of nonsurgical rhinoplasty treatments with the HA filler, VYC-25L, in "real world" clinical practice.

METHODS

This was a retrospective analysis of consecutive adult patients undergoing nonsurgical rhinoplasty with VYC-25L by a single injector between January 2020 and July 2022. All patients received initial treatment (typically ~0.3-0.5 mL of filler) and touch-up at 4-6 weeks (~0.1-0.3 mL). Safety data were collected throughout a mean follow-up of 11.1 months. Patient satisfaction was assessed using the FACE-Q Satisfaction with Nose and Satisfaction with Outcome questionnaires.

RESULTS

A total of 492 patients were included (984 treatment sessions including touch-ups). Of these, 467 (94.9%) were female and the mean age was 30.0 years. All treatments were associated with early transient edema; other adverse events included bruising (n = 123; 25%), residual asymmetry (n = 18; 3.7%), and suspected localized vascular occlusion (n = 3; 0.6%). The latter cases were easily resolved with hyaluronidase injection plus oral steroid and aspirin. No patients experienced infection, necrosis, blindness, lumps, granuloma, or delayed-onset nodules. Mean Rasch-transformed FACE-Q scores were 90.2% for Satisfaction with Nose and 99.2% for Satisfaction with Outcome.

CONCLUSIONS

In a large cohort of patients treated in routine practice based on a systematic approach, nonsurgical rhinoplasty with VYC-25L was safe and effective.

The Use of Hyaluronic Acid in Non-surgical Rhinoplasty: A Systematic Review of Complications, Clinical, and Patient-Reported Outcomes

INTRODUCTION

In cosmetic practices, non-surgical rhinoplasty using filler injections has become increasingly common. Nevertheless, the outcome and overall complications have not been studied as a systematic review in the literature. This study provides a high-quality systematic review of studies reporting clinical and patient-reported outcomes following non-surgical rhinoplasty with hyaluronic acid (HA) to further guide practitioners.

METHODS

This systematic review was conducted in accordance with PRISMA guidelines and was registered in PROSPERO. The search was conducted using MEDLINE, EMBASE, and Cochrane. The literature retrieval was conducted by three independent reviewers, and the remaining articles were screened by two independent reviewers. The quality of included articles was assessed using the MINORS and methodological quality and synthesis of case series and case reports tools.

RESULTS

A total of 874 publications were found based on the search criteria. A total of 3928 patients were reviewed for this systematic review from 23 full-text articles. For non-surgical rhinoplasty, Juvéderm ultra was the most commonly used HA filler. The nasal tip was most commonly injected (13 studies), followed by the columella (12 studies). Nasal hump deformities are the most common reason for non-surgical rhinoplasty. All studies showed high patient satisfaction. Among all patients reviewed, eight developed major complications.

CONCLUSION

Non-surgical rhinoplasty performed with HA has minimal side effects and a short recovery period. Furthermore, non-surgical rhinoplasty with HA results in high satisfaction. To strengthen the presently available evidence, further well-designed RCTs are needed.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266.

Non-surgical Rhinoplasty (NSR): A Systematic Review of Its Techniques, Outcomes, and Patient Satisfaction

Surgical rhinoplasty (SR), commonly known as nose job, is a widely practiced cosmetic surgery globally, aimed at addressing diverse aesthetic and functional concerns related to the nose. In recent years, non-surgical rhinoplasty (NSR) has gained popularity due to advanced techniques involving hyaluronic acid (HA) dermal fillers, offering advantages such as affordability, reduced side effects, and faster results. However, concerns persist about the suitability of dermal fillers for nasal anatomy and potential complications, prompting this comprehensive review. This study systematically evaluated the techniques, fillers, safety, and patient satisfaction associated with NSR, with the intent of providing valuable insights for clinicians and patients considering NSR or SR for improved aesthetic outcomes. The literature search, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, yielded 16 relevant studies from an initial pool of 1002 articles. These studies covered various aspects of NSR, including techniques, complications, limitations, and positive results. In conclusion, NSR appears to be a quick and safe option for addressing minor nose shape issues, particularly through the use of HA fillers, but further discussion and standardization are necessary to address risks and limitations. A randomized controlled trial (RCT) using photographic evidence could significantly propel the progress of this evolving treatment. RCTs offer an optimal method to assess NSR's adverse effects and overall outcomes by allowing controlled comparisons between treatment and control groups. This approach minimizes biases and generates reliable statistical data, which is critical for evaluating safety, efficacy, and potential risks, thereby guiding informed clinical decisions.