Non-surgical Rhinoplasty: PDO Threads vs. Fillers

According to Nonsurgical Rhinoplasty With Polydioxanone Threads and Fillers (2019) Asians typically have a smaller and a less distinct nose, and thus, cosmetic nose enhancement procedures are popular.


For decades, surgical rhinoplasty has been the treatment of choice. However, with the advent of various synthetic fillers, nonsurgical rhinoplasty with injectable fillers & PDO sutures has gained popularity over the years. You see, as we get older, our bodies gradually produce less and less collagen, reducing skin thickness and strength as we age. With aging, skin loses its ability to support the tissues underneath it. This, combined with gravity, pulls the skin down and stretches it. Helping to bring fresh collagen to the skin can help combat this.


To solve this issue, PDO threads can help to provide ongoing rejuvenation for the facial tissue. In fact, type 1 collagen and elastic forms around the thread, and has been seen after just 6 weeks in cross sections.


Polydioxanone (PDO)

What are PDO Threads? PDO is an absorbable polymer that is flexible and durable. The threads can be thought of as sutures, and there are three different types: Mono threads, smooth, and cog. Mono threads are smooth and singular sutures that provide a small lift. Cog threads have more of a barbed texture, provide a bit more of a lift. Screw threads have multiple threads intertwined and provide more volume to the treated area. The best part about these threads – they will stimulate natural collagen production.


FILLER for Non-surgical Rhinoplasty

One of the most popular way to perform rhinoplasty is with filler. The major strength of filler rhinoplasty is that it can provide immediate, visible results in the convenience of an office setting. Despite its temporary longevity, it is popular because it is simple, effective, and economical.



A successful Asian rhinoplasty requires comprehensive correction of the dorsal and caudal aspects of the nose. Fillers add volume to the soft tissues, and filler rhinoplasty is quite successful in raising the nasal dorsum in Asians.


However, unlike surgical rhinoplasty, it is limited in its ability to produce a significant change in the caudal aspect of the nose. In the Asian population, the nasal tip is often under projected, and for nonsurgical rhinoplasty to produce a more pleas- ing appearance, it needs to reliably raise the tip and modify the nasolabial angle. So far, however, outcomes after filler rhinoplasty have not been so consistent or reliably reproducible in this part.


To overcome the limitations of filler rhinoplasty, PDO thread lifting can be introduced as a technique in which wedge-shaped sutures are inserted to the nasal dorsum and columella.


THREAD LIFTING for Non-surgical Rhinoplasty

Other than face lifting, threads also can be used for nonsurgical rhinoplasty. Polydioxanone (PDO) is a synthetic polymer which hydrolyzes over a period of 6 months. Its absorbable nature prevents the long-term complications associated with alloplastic implants such as infection or extrusion. In addition, it has been reported that the breakdown products of PDO have bacteriostatic properties. With the addition of barbs to PDO suture, the load-bearing ability of wrinkle suspension sutures has increased. Barbed PDO, especially those which are multidirectional, also maintains tension without sagging or slipping, which is an extremely favorable quality in the lifting-up the nasal tip.


The Asian nose is typified by a flat nasal bridge, indistinct nasal dorsum, under projected and broad nasal tip, and a short columella. In the past, Asian rhinoplasty mainly focused on dorsal augmentation. At present, augmentation of the nasal tip is very popular and is considered an important aspect of achieving a natural and balanced nose.



Above is a schematic diagram to showcase the thread insertion procedure.


For the nasal dorsum, after puncturing the entry point (2–3 mm below the nasal tip) with an 18-G needle, a 5-cm-long, 18-G guided cannula to be inserted to the subcutaneous plane, covering the entire length of the dorsum in the midline from the radix to the tip.


After removing the guide from the cannula, a 1-0 multidirectional wedge-shaped PDO suture (6 cm in length) will be placed inside the cannula, and the cannula is subsequently removed. The suture material exposed at the entry point needs to be trimmed off. Around 3 to 5 barbed PDO threads can be inserted into the nasal dorsum.



As for the caudal part of the nose, after puncturing the entry point (1 mm below the subnasale) with a needle, insert a 1-0 multidirectional PDO thread from the subnasale to the nasal tip using a bent, 5-cm- long, 18-G cannula. The PDO thread will be folded in half to place half of the material (3–4 cm) inside the cannula and the other half outside.


After removing the cannula, the suture material is to be trimmed off at the entry point and pushed inside. With the columella being pushed back (fully extended) with the operator’s finger during the process., a total of 3 to 5 barbed PDO threads can be stacked at this site.


PROCESS & RECOVERY

Local anesthesia is used to help numb the areas of treatment, as it is non-invasive. Depending on the area and a client’s individual needs, treatment can include anywhere from 2-20 threads (sometimes more) and can take as little as an hour to two hours. Thin threads are inserted into the skin through tiny incisions made to the targeted area. The threads then attach to the skin tissue and are pulled into place to help lift and smooth the skin. The threads are then knotted together and become hidden within the skin itself, leaving an immediate improvement in appearance.


The purpose of fillers and threads are largely different as fillers are mostly injected to the nasal dorsum to correct irregularities/augment the nasal shaft. On the other hand, the main target of threads is the nasal tip.


Barbed PDO threads and fillers act synergistically in the nasal dorsum. Here, they act as reinforced concrete, a composite material where the concrete (filler)’s relatively low tensile strength and ductility are counteracted by the inclusion of reinforcement (barbed PDO) having a higher tensile strength or ductility.


Threads lengthen, strengthen, and raise the columella, enabling the tip to project in the anterior direction. This makes the tip pointier. Also, by lengthening the columella, threads improve nostril inclination and stretch the ala in the anterior direction. With the changes, the nose becomes long and narrow (leptorrhine) when seen from the basal angle.


Because the area is treated with an anesthetic, PDO Thread lifts can be surprisingly comfortable, with clients reporting little to no discomfort. As with any cosmetic procedure, there may be some temporary swelling, bruising, or redness for just a few days afterwards. Results can be expected to develop within 4-6 weeks. Results can last anywhere from one to three years.


CONCLUSION

Nonsurgical rhinoplasty combining PDO threads and fillers can be safe and effective, maintaining good results at 6 months after the procedure. Threads are especially useful for lifting-up the nasal tip, contributing to a more harmonious and pleasing nasal appearance by modifying the columellalabial angle.


REFERENCE

Nonsurgical Rhinoplasty With Polydioxanone Threads and Fillers published by American Society for Dermatologic Surgery Inc (2019)

COMMON AESTHETIC CONCERNS seen in the ASIAN NOSE: Part 2: THE SHORT NOSE, THE FLARING NOSE AND NOSTRIL SHOW. Published on waesthetics in THE NOSE and RHINOPLASTY (2013)

WHAT ARE PDO THREADS AND HOW DO THEY WORK? By REGENESISMD (2021)

Face-lift > Patient Care & Health Information > Tests & Procedures Published on Mayoclinic.org (2022)

Filler rhinoplasty based on anatomy: The dual plane technique published by JPRAS Open Volume 20, June 2019, Pages 94-100


 

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