Recently, patients of plastic surgeons are less likely to agree to lengthy procedures that require a long recovery period. Sometimes it is really possible to correct aesthetic imperfections with the help of fairly effective minimally invasive techniques using fillers, botulinum toxin or threads.
But there are very few procedures that could serve as an alternative to surgical rhinoplasty. In some cases, to obtain satisfactory aesthetic results, it is enough to perform a nose lift with threads.
In this article, Dr. Nejat Can describes a simple procedure that can be performed under local anesthesia in minutes. The lack of downtime makes it possible to combine the described technique with other minimally invasive correction methods.
Anatomy of the zone: what features should be taken into account
The outer part of the nose is pyramidal in shape. The root of the nose is located on top, and its rounded tip – from below. Between the base and the tip is the back of the nose. Nostrils – pear-shaped openings leading to the vestibule of the nasal cavity are medially demarcated by the nasal septum, and laterally – nose wings.
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The skeleton of the outer part of the nose consists of cartilaginous and bony components. The bone component is located on top and is formed by the frontal, nasal and maxillary bones. The inferior cartilage consists of one septal cartilage, two lateral cartilages, two alar cartilages, and smaller alar cartilages. While the skin over the oblique part of the nose is thin, in its cartilaginous part it is thicker and contains sebaceous glands.
Fig. 1: outer part of the nose
Rhinoplasty with Aptos Excellence Visage threads: patients and methods
Minimally invasive rhinoplasty with Aptos threads was performed on 28 patients (21-50 years old) who asked the author to correct the shape of the nose. The follow-up period for patients after the procedure was 8-12 months.
Aptos Excellence – absorbable threads, 75% poly-L-lactic acid and 25% caprolactone, with multi-directional notches for lifting and reinforcement.
The absence of a rehabilitation period makes it possible to combine the described technique with other minimally invasive correction methods.
These threads are characterized by a special arrangement of notches: each next notch is directed oppositely to the previous one, which provides a stronger attachment to the hypodermis and tissue support. Threads are inserted using a safe and tissue-friendly hollow cannula with a round tip.
Nose reduction: minimally traumatic rhinoplasty technique
Nose tip lifting with Aptos threads: surgical technique
Before the procedure, the midline and the most protruding points of the domes of the nose were marked; injections of local anesthetic (adrenaline solution) were performed in the back, caudal part of the nasal septum and columella.
Fig. 2: cartilage components
An entry point was created using an 18 gauge needle through the tip of the nose (Figure 3).
Performing procedure
1. With the help of Aptos Excellence Visage threads, the angle of the columella is increased by moving it through the entry point and inserting the thread into the cartilaginous septum of the nose. The cannula is not removed from the nose during the entire procedure – by moving it back and forth, the entire 190 mm long thread is installed in the columella (Fig. 6).
Fig. 3: entry point
2. The thread moves along the back, starting from the entry point, and is installed above the periosteum of the nose. Then, in order to raise the bridge of the nose, the thread is directed to the mid-eyebrow (Fig. 7).
Fig. 6: the first step: increase the angle of the columella
Fig. 7: second step: reshaping the bridge of the nose
During the operation, the degree of change and the exact effect can be determined by observing the rotation of the tip of the nose as the thread is tightened. This is a very important stage in which it is necessary to assess the degree of rotation and projection of the nasal tip. In all cases, a slight overcorrection is recommended.
Time of procedure – 30 minutes.
Lifting the tip of the nose with Aptos threads: correction results
In 20 out of 28 cases, patients were satisfied with the results of the operation.
Fig. Fig. 8: patient before and after nose lift with optimization of nasolabial and nasolabial angles
Three patients underwent the procedure again after 6 months. Five patients subsequently underwent conventional rhinoplasty.
The final results of the correction appear after about 3 months and remain throughout the entire follow-up period (12 months).
Nose lift with Aptos threads is also very effective in secondary rhinoplasty. After reducing the initial projection and rotation (a consequence of overcorrection), the results were maintained throughout the entire observation period.
Filigree profile: subtleties of rhinoplasty
The final results of the correction appear after about 3 months and remain throughout the entire follow-up period (12 months).
There were no complications associated with absorbable sutures, such as palpability or contouring.
Fig. 9 and 10: Patients before and after a nose lift with optimization of the nasolabial and nasolabial angles
The rapid growth of scar tissue at the junction of the skin acts as a biological glue that maintains the new position of the tip of the nose. It takes about three to four weeks to achieve powerful subcutaneous fibrosis. Therefore, if necessary, absorbable Aptos Excellence Visage threads can be removed during this period, which is an advantage of the procedure in the eyes of patients.
According to Prime magazine
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