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NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. 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 .

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The aim of this narrative-style review was to evaluate non-surgical rhinoplasty in terms of indications, outcomes, and limitations. Both 'PubMed' and 'Science Direct' were reviewed by all authors, in order to reach consensus with regard to the chosen studies. Studies published from 1980 to 2023 were searched using the key terms "non-surgical rhinoplasty", "dermal filler", "thread lifting", and "botulinum toxin", and relevant papers were selected. Non-surgical rhinoplasty refers to the use of injectable temporary fillers to augment selected areas of the nose, in order to achieve improved appearance or function in select patients. It includes the use of dermal fillers, thread lifting, and botulinum toxin injections. The perfect dermal filler would be inexpensive, safe, painless to inject, hypoallergenic, and long lasting. In addition, it should produce consistent and predictable results, feel natural under the skin, take little time to inject, be ready to use, exert no downtime on the patient, and have a low risk of complications. Regions of the nose treated with filler injections include the frontonasal angle, dorsum, nasolabial angle, and columella. Thread lifting and botulinum toxin injection are the other methods of non-surgical rhinoplasty. Dermal fillers, thread lifting, and botulinum toxin injections can be used as non-surgical rhinoplasty. Dermal fillers and botulinum neurotoxin can be used alongside each other to allow minimally invasive resculpting of the nasal region and midface, compensating for a reduction in tissue volume and the formation of rhytides.

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INTRODUCTION: Projection and upper rotation to the tip is fundamental in the nasal rejuvenation, as a matter of fact the tip is the most important and has strongly effects on the improve appearance and quality of life. The aim of the present study was to evaluate reshaping the tip of the nose by cross-linked hyaluronic acid using Italian technique. METHODS: In a period between November 2019 and 2023, a total of one hundred and forty healthy, 95 females and 45 man patients, were performed with a mean age 44±5 (age range: 31-52 years old) affected by tip of congenital (22) or ageing nose hypotonia (118), and reduced volume that need of an elevation of the nose tip. The anatomic markers have been considered for the anthropometric measurements after the filler rhinoplasty. Two infiltrations were performed, one in the infiltration into the antero-caudal access over the columella produce upward rotation of the tip of the nose and second infiltration into the antero-superior access produce the projection of the tip of the nose. Medical device used in the study was Neofound STRUCT LIDO (LOVE COSMEDICAL srls-Via Toniolo 9, 57022 Castagneto Carducci, ITALY) containing sodium hyaluronate/hyaluronic acid high molecular weight (1.500

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BACKGROUND: This review addresses the intricacies of non-surgical rhinoplasty, particularly focusing on the utilization of absorbable sutures known as "Volumizing threads" in combination with fillers. The aim is to explore the enhanced precision of nasal contouring offered by these combined procedures compared to sole filler injections. METHODS: Through comprehensive clinical cases, this article scrutinizes the landscape of adverse effects and their prevention strategies associated with minimal invasive nose thread procedures. The discussion emphasizes various complications, including thread protrusion, migration, infections, skin dimpling, and granuloma formation, along with their respective management approaches. RESULTS: This article delineates cases of complications arising from thread placement, ranging from visibility issues to skin infections and granuloma formation. It highlights instances of thread visibility, oral mucosa protrusion, skin infections, dimpling, and granuloma formation. Additionally, it outlines the corresponding management strategies, accentuating the criticality of early intervention to preclude severe complications in non-surgical rhinoplasty involving nose threads. CONCLUSION: Non-surgical rhinoplasty, leveraging nose thread procedures, offers heightened precision compared to conventional filler injections. However, the review underscores the importance of recognizing potential risks and promptly addressing complications like thread extrusion, migration, and infections. Understanding these complexities in non-surgical rhinoplasty aids in informed decision-making and efficient patient care.

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OBJECTIVE: To demonstrate the effects of PDO threads non-surgical rhinoplasty on patients' quality of life (using FACE-Q Scale) and first impression assessments. METHODS: This is a prospective cohort study of 10 adult patients who sought non surgical rhinoplasty to improve tip rotation or reduce the appearance of a dorsal hump. All patients fulfilled the study's enrollment criteria. Prior to treatment, patients completed pre-treatment FACE-Q surveys and pre-treatment photos were obtained. Each patient was treated with the appropriate size and number of PDO threads necessary to achieve optimal correction result (OCR). Two weeks after treatment, the patient completed posttreatment FACE-Q surveys and posttreatment photos were obtained and analyzed. First impression surveys were created using pre- and posttreatment photos, and the survey was completed by 146 blinded evaluators. RESULTS: There was statistically significant improvement in the FACE-Q scores for social function (p = 0.02), psychological function (p = 0.0009) and satisfaction with nose (p = 0.0001). There was significant reduction in scores for appearance related psychosocial distress (p = 0.03). For the first impression surveys, there was a statistically significant improvement (p = 0.029) in the attractiveness scale posttreatment. Although not statistically significant, there was reduction of the dorsal hump (p = 0.15) and increase in the nasolabial angle (p = 0.48) and Goode's ratio (p = 0.16). There were no major adverse events or complications. CONCLUSION: This study shows that the PDO threads alone can be used safely to achieve minor nasal changes especially in tip rotation and appearance of dorsal hump, to improve patients' quality of life, and perceived attractiveness of treated patients.

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We reviewed the article titled "The Use of Hyaluronic Acid in Non-surgical Rhinoplasty: A Systematic Review of Complications, Clinical, and Patient-Reported Outcomes" authored by Mortada et al. in Aesthetic Plastic Surgery with considerable interest. This study presents a meticulous systematic review of research examining clinical and patient-reported results in hyaluronic acid (HA) non-surgical rhinoplasty. However, we hold specific reservations about the methodologies employed in the studies encompassed within their analysis. Precise comprehension of the properties of the utilized active substance is essential for any treatment, with standardization being a key factor. Understanding the essential characteristics of the administered HAs is pivotal to establish potential connections between these attributes, outcomes, and complications. Of particular importance in the clinical application of tissue volumization via fillers is rheology, the study of material flow and deformation under stress. Gaining insight into HA's rheological properties is imperative when selecting an appropriate dermal filler for nasal applications. Three pivotal HA properties are viscosity, elasticity, and cohesiveness. While appreciating the authors' contributions, further analysis should account for these factors in their investigation.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 .

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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.

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INTRODUCTION: Non-surgical rhinoplasty is one of the terms used to describe the technique of injecting fillers into the nasal pyramid region for aesthetic, and sometimes functional, purposes. Although it is now an extremely popular practice, the techniques proposed and the products used are different. This inhomogeneity is also found regarding the treatment longevity. METHOD: A literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). It was realized to collect information on this disputed topic. Pubmed/MEDLINE database was explored. RESULTS: A total of 228 articles were extracted from the basic literature search. 81 of these were excluded based on the content of the title and abstract. All 147 remaining articles were submitted for full-reading. 49 of these were excluded because the injection product used by the authors was not a hyaluronic acid based filler; while 82 of these were excluded because they provided no indication regarding the longevity of the treatment. Of the 16 selected studies, according to six authors, the duration of treatment is therefore between 8 and 12 months. For all the others, instead, the results seem to last longer than this period. The longest time interval was 8 years. DISCUSSION AND CONCLUSION: Establishing with certainty the longevity of non-surgical rhinoplasty seemed to be extremely complex. In the light of this discordant data seems to be essential to deepen the argument. A study using imaging techniques and/or standardized photographic material appears essential to further investigate this controversial topic.

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BACKGROUND: In the last few years, facial rejuvenation has moved to less invasive or non-surgical techniques because their effects are visible immediately after the treatment, they have shorter recovery time and less pain and patients can go back to their normal life on the same day. Rhinoplasty is a cosmetic procedure that is very difficult to master. The main goal of rhinoplasty is anatomical preservation. One of novel technique for nose remodeling is laser therapy. In this study, the authors evaluate the efficacy of the endolift laser as a technique for nose remodeling. METHODS: A total of eight patients were enrolled and were submitted to endolift laser therapy. The outcomes were measured by photography, three blind board-certified dermatologists assessment, and patients satisfaction. RESULTS: Our results showed that endolift Laser as non-surgical nose remodeling technique is a safe and effective method. Clinical assessment of the physician showed a significant improvement at 6-months follow-up. Also, the patient satisfaction rate was higher in the enrolled participates. Also, no severe side effect was reported. CONCLUSION: The endolift laser technique is practicable, effective, and safe method for non-surgical nose job and has no major complication.

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Nasal enhancement is one of the most challenging and intriguing of aesthetic procedures. Although the nose is the most central and prominent facial feature, it should not be dominant while maintaining both a harmonious relationship with the face and its own intrinsic beauty. In this article, the first author shares his experience on how to specifically apply intradermal soft-tissue fillers (for particular indications) in nasal enhancement and incorporates patient assessment, anatomy of the nose, and injection techniques to provide guidance. Intradermal injections are required for specific regions, as for example in the treatment of internal and external valve collapse; however, several precautionary measures need to be implemented to minimize risks resulting in vascular compromise.

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Injecting soft-tissue fillers in the nose requires a very specific approach, as vascular-related adverse events are a pivotal concern. This study describes a novel standardized 4-step treatment algorithm for safe, reproducible, and effective liquid rhinoplasty procedures using a "deep columellar approach." Medical records of n = 511 treatments were retrospectively analyzed with respect to the occurrence and severity of adverse events. The low rate and severity reported for such incidents can be correlated to a precise and verifiable filler placement in the deep, supraperiosteal, and supraperichondrial layers, using blunt cannulas.

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BACKGROUND: The nose is a central visual feature of the face leading many patients wishing to improve their facial esthetic appearance to undergo rhinoplasty. Increasingly more patients are seeking non-surgical alternatives such as hyaluronic acid filler injections. These treatments have the ability to profoundly impact patients' esthetic appearance and first impressions. OBJECTIVE: To evaluate the effects of hyaluronic acid filler injection in non-surgical nasal augmentation on first impressions, quality of life, and to evaluate treatment efficacy in reducing the height of the nasal dorsal convexity. METHODS: Ten female subjects underwent small-particle hyaluronic acid filler injection into the nasal soft tissues. Photographs of the subjects were taken at baseline and post-treatment after achieving an optimal correction result. Patients reported satisfaction with outcomes using a validated patient-reported outcome measurement tool. Blinded evaluators were used to assess first impressions across specifically defined categories using the baseline and post-treatment photographs. The height of the pre and post-injection nasal dorsal convexity was compared. RESULTS: All patients experienced a statistically significant reduction in the height of their dorsal nasal convexity. There was significant improvement in patient-reported outcomes based on all measures of the FACE-Q scale. A total of 224 evaluators completed blinded assessments of first impressions. Mean first impressions in all eight categories, along with overall first impression score showed statistically significant improvement following treatment. CONCLUSION: Hyaluronic acid filler injections for non-surgical nasal reshaping are a safe and effective method to improve perceived first impressions and to improve patient-reported self-esteem and esthetic satisfaction with their nose.

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BACKGROUND: In recent years, there has been a rise in non-surgical rhinoplasty (NSR) due to its minimally invasive approach. As with all procedures, NSR can result in complications. Although rare, the consequences of complications can result in a devastating outcome and therefore an evidence-based approach to enable the recognition and management of NSR complications is required. AIMS: This paper aims to review and appraise current literature to determine the evidence base for complications experienced with NSR including their causes and management. METHODS: A systematic review was conducted using a PRISMA methodology. The PubMed and WebofScience databases were queried. Papers relating to the three most commonly used filler materials; hyaluronic acid (HA), calcium hydroxyapatite and collagen were collated. RESULTS: Four hundred and ninety studies were identified in the initial literature search and after applying an inclusion and exclusion criteria, 12 papers were included. CONCLUSION: The results of this literature review showed a paucity of high-level evidence which may indicate underreporting of NSR complications. Although treatment is not always effective, it is clear that early recognition and treatment favors better outcomes with the potential for complete resolution in some cases. Immediate availability of hyaluronidase is important when undertaking NSR with HA as this review showed early use was critical in the management of serious complications such as vascular occlusion.

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Rhinoplasty is a commonly performed cosmetic surgery. Clinicians are facing an increased demand on non-surgical procedures, therefore liquid rhinoplasty is gaining popularity. Given the characteristic of lipofilling to rejuvenate and improve skin texture, fat grafting can be used to reshape the nose in secondary rhinoplasty. Fat was injected in 27 patients with a mean age of 42 years. Volume of fat ranged from 1.5 to 4.5 cc with a mean of 2.2 cc. Patients were seen at 1 week, 3 months, 6 months, and 1 year. Patient satisfaction was measured using the Rhinoplasty Outcome Evaluation questionnaire and plastic surgeons' evaluation. After 1 year follow up, 20 patients were satisfied with the results at 1 year. The aesthetic outcome was noted as very good in 11 patients, good in 9 patients, and poor in 3 patients. Most of the patients had an improvement in skin texture with trophic effect on the skin. No complications were seen in our series According to this study, nasal lipofilling is a safe and efficacious filler in secondary rhinoplasty. However, more studies are needed to assess the indications and limitations of nose lipofilling.

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BACKGROUND: Non-surgical rhinoplasty using hyaluronic acid dermal fillers is a cosmetic procedure that has been becoming increasingly popular among patients wanting to correct nasal deformities or nasal irregularities, in the recent years. AIM: This systematic review aims to provide quality evidence about the success of non-surgical rhinoplasty procedures in terms of patient satisfaction and complications. METHODS: A systematic electronic literature search using keywords and MESH search terms over the PubMed/Medline, Cochrane Central, Scopus, and EBSCO online databases was conducted from November 2005 to February 2021. Additionally, the reference lists of included systematic reviews were hand searched. Data collected included patient satisfaction and complications from prospective and experimental studies providing highest level of evidence. Articles were critically appraised, and MINORS scale was used to assess the risk of bias. RESULTS: Based on the search criteria, 2896 citations were found. After removing duplicates and screening for relevance, 23 citations were finalized for full-text review, of which 12 articles were excluded and 11 articles were included in the study. The average satisfaction of patients amongst the studies was found to be >90%. In all the studies, transient edema and erythema, post-injection pain, and bruising were some temporary complications. Rare complications that were reported were vascular impairments and hematoma. CONCLUSIONS: Non-surgical rhinoplasty is a good, minimally invasive alternative over conventional rhinoplasty. There is however a paucity of quality data in the form of experimental and prospective studies regarding the accuracy, effectiveness, and complications of non-surgical rhinoplasty.

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This study was intended to assess the utility of hyaluronic acid dermal fillers in patients who do not wish surgery in addition to the patients with minor post-surgery asymmetries. This was a prospective study which included post-surgery patients for minor nasal asymmetries, patients unwilling for surgery and those waiting for revision surgery. It is of great use in candidates who do not wish surgery but had the desire for different nasal appearance especially for important life events like marriage etc. This study included 20 patients with follow up period of 18 months. The results were compared on Nasal Imperfection Scale and Rhinoplasty Outcome Evaluation along with pre and post injection photographs. Nasal Imperfection Scale difference of 5 and Rhinoplasty Outcome Evaluation Scale differential of 50 is considered to be significant, which was observed in all individual cases. The growing need of medical rhinoplasty by the patient as well as surgeons has led to the introduction of fillers. Hyaluronic acid fillers are safe, easy and effective dermal fillers for patients undergoing all the expected indications of medical rhinoplasty. There is also growing number of candidates who wish for a 'nose job' for desired changes without coming under surgeon's scalpel. Our clinical experience with 20 patients has been described with satisfactory results.

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INTRODUCTION: Non-surgical rhinoplasty or liquid/filler rhinoplasty is one of the fastest-growing cosmetic procedures worldwide. While several papers have been published on this topic, there has been no standardization of the technique. Most techniques advise injection in a top-down manner, similar to a traditional rhinoplasty. We present our ascending technique performed in 2130 cases. This constitutes one of the largest series published on this subject. METHODS: Patient records were retrospectively analysed from 2006 to 2019. All patients were injected with hyaluronic acid fillers. We employed an ascending approach which consisted of four sites: nasal tip, columellar base, dorsum (including supratip) and radix. The tip was first set at the appropriate projection and rotation and then the dorsum adjusted to meet it. RESULTS: Since 2006, 2130 patients underwent non-surgical rhinoplasty; 2023 patients were female (95%), and 107 were male (5%). The proportions by site injected were tip 95%, columella 58%, dorsum 83%, radix 62%. Sixty-two percent (1321) repeated the procedure after 1 year. Two percent of patients had persistent tip redness which recovered. There was no skin necrosis or ocular complications. CONCLUSIONS: In non-surgical rhinoplasty, all modifications are being done by pure addition, unlike surgical rhinoplasty. In this scenario, the risk of over-projecting the tip is higher. Hence, we believe it is important to set the tip at the desired projection and size and then raise the dorsum accordingly to match. Our high satisfaction rate over 2130 patients validates the efficacy of this ascending technique. 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 .

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BACKGROUND: An increasing number of people are undergoing non-surgical aesthetic procedures, especially injections of botulinum toxin and dermal fillers. While toxin injections have lower rates of complications, profound and serious consequences can arise with the use of dermal fillers. CASE: A 29-year-old woman presented to the eye casualty department with sudden visual loss, ptosis and ophthalmoplegia after having had non-surgical rhinoplasty in a beauty salon in West London. The filler was administered by a healthcare professional not registered with the General Medical Council (GMC) or similar governing body. DISCUSSION: Despite prompt measures on arrival at our service, the symptoms of visual loss, ptosis and ophthalmoplegia persisted. Attempts from the patient and medical services to report the incident (to trading standards and the police) were to no avail. CONCLUSION: This case highlights the poor treatment response to filler-related ophthalmic complications. It is also evident that in the United Kingdom, there appears to be poor regulation in the use of these products, a lack of clear guidelines for the management of their complications and finally no recourse for patients to challenge practitioners who lack medical registration and are not held accountable.

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Non-surgical rhinoplasty is becoming an increasingly common procedure to alter the appearance and cosmesis of the nose. Although rare, complications with this procedure do exist, some of which can be devastating. Major complications include infection, vascular compromise, skin necrosis, and blindness. Here we discuss the nasal anatomy, complications associated with non-surgical rhinoplasty, and techniques to prevent these complications.

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