Facial Rejuvenation: Approach to Nose Thread Lifting Techniques
While surgical rhinoplasty is the preferred method for treating nasal deformities, not all patients seeking cosmetic nasal surgery require a full rhinoplasty procedure. In recent years, the use of dermal fillers has become popular for non-surgical nose treatments due to their availability, minimal invasiveness, and quick recovery time. However, the procedure carries some risks due to the complex vascular anatomy of the nasal skin. Sutures are commonly used in rhinoplasty procedures to achieve nasal tip projection and reshaping, as well as in aesthetic surgery for tissue lifting.
Nose thread lifting is a new technique introduced to allow for non-surgical correction of nose morphology issues. However, it lacks standardisation and may provide inconsistent results with limited longevity.
In this blog, we explore a reliable methodological approach, introducing thread lifting techniques using poly-L-lactic/poly-caprolactone threads, which are similar to graft-based methods. This is a reliable and safe approach to obtain temporary amelioration of selected nose defects via a nonsurgical and minimally invasive method.
Preoperative Assessment
1) Skin Type and Texture
Prior to performing thread lifting of the nose, it is crucial to assess the skin type and texture. Thick and sebaceous skin may not drape as well as thin skin and may take longer for the swelling to subside, delaying the desired results. Conversely, thin skin can sometimes excessively drape, and as swelling decreases, the underlying thread loops may become visible.
2) Nasal Bones and Cartilaginous Framework
Since there is no surgical dissection involved and all cartilage corrections are planned in advance, it is highly recommended to palpate and assess the length of the nasal bones and cartilaginous framework before thread insertion. This assessment should include checking for any bony or cartilaginous irregularities along the midline or lateral aspects of the dorsum.
3) Septal Cartilage
It is also important to evaluate the antero-inferior portion of the septal cartilage, which is typically hidden between the two domes, in relation to the most projecting point of the lobule.
4) Cartilaginous Dorsum
Finally, assessing the resistance offered by the cartilaginous dorsum and nasal tip to posterior displacement completes the essential structural evaluation.
Nose Morphology Correction Methods
The procedure begins with skin disinfection using iodopovidone or chlorhexidine, followed by local anesthesia of the nostrils and columella using a solution of adrenaline and lidocaine. The tip and dorsum are anesthetized through cannula infiltration.
After vasoconstriction, threads are inserted using two techniques: Cannula and Sole Rhinoplasty Needle Methods using resorbable PDO/PCL suspension threads.
1) Cannula Method
The Cannula Method involves using a resorbable 2/0 thread preloaded in a blunt cannula. This method is considered safe and requires less technical skill. The thread provides a supportive framework for nasal tissues once inserted.
In this method, an 18G needle is used to open the insertion point on the nose tip. The thread is then inserted and fixed in the nasal superficial muscular aponeurotic system above the nose root, creating a framework. The cannula is retracted and the thread is fixed along the dorsum tissues. The cannula is flipped without exiting the skin and inserted inwards to the nasal spine via the columella. This process is repeated using the entire thread length to define the new framework. The barbs of the thread strengthen the columella, correct tip position and projection, and address dorsum defects.
See below the figure showing the lateral view, before treatment using cannula thread (left) and the lateral view 1.5 years after treatment (right). (From Sulamanidze et al, 2023)
2) Sole Rhinoplasty Needle Method
The Sole Rhinoplasty Needle method uses a resorbable PLLA-PCA 2/0 thread inserted in the middle of a double sharp-ended needle. The barbs in this method are monodirectional in each half of the thread. The main fixation point is located at the insertion point on the nasal root, and the barbs distribute the thread's tension along its length. This method is more effective for addressing major deformities as it suspends the nose from its insertion point and securely holds the nasal tissues with loops.
This method involves inserting two needles at the nose root. One needle is passed down along the dorsal line toward the tip, creating a loop around the alar cartilage. It then goes back to the nasal root. The second needle is inserted in the same manner on the opposite side, forming a double loop around the nasal tip and domes. Moving the tip upward allows for maximum correction, and the loops and barbs secure the new position and adjust tip projection.
See below the figure showing the lateral view, before treatment using needle thread and the lateral view 1.8 years after treatment (right). (From Sulamanidze et al, 2023)
See below the flowchart guiding the selection of the appropriate correction methods for different indications. (From Sulamanidze et al, 2023)
For nasal dorsum correction, the tip is lifted to assess tissue volumes. Multiple loops of the thread are created using circular movements of the cannula to add volume and address concave dorsum or dorsal hump. To modify the naso-frontal angle, the thread is inserted upward and downward to the procerus muscle.
External nasal valve problems can be addressed by inserting threads parallel to the nostril margin, above the lateral dome, acting as an alar batten graft to strengthen the cartilaginous framework and prevent collapse during breathing.
Pain control is achieved with oral paracetamol. The authors provide a flow chart to guide operators in selecting the appropriate correction methods for different indications.
Conclusion
Surgeons are under pressure to simplify procedures and reduce scars, operating time, and recovery period in response to patient demands. While suture techniques for rhinoplasty are well-established, minimally invasive procedures using resorbable threads for nasal shape correction have only recently been described.
Thread nose reshaping can effectively address various flaws, whether they are natural or a result of primary rhinoplasty. Fibrosis or scar tissue can increase the risk of relapse, and using a thread loaded on a needle is preferable in such cases. Nonsurgical procedures for nose reshaping can be performed safely in selected patients, offering quick and easy treatment. The threads work as internal splints, providing mechanical support and tissue thickening.
Overall, thread lifting for medical nose reshaping offers a safe alternative with minimal risk compared to procedures involving injectables. The threads can be removed if necessary, filling the current safety gap and presenting a promising paradigm for the future of medical nose reshaping.
Reference:
Thread Lifting of the Nose: Fully Comprehensive Approach to the Technique (2023)
Thread Lifts: A Critical Analysis of Treatment Modalities (2020)
Thread-Lift Sutures: Anatomy, Technique, and Review of Current Literature (2019)
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