why do it?
The nose is a prominent facial feature and one of the first things people see in a face. Compared to Western beauty standards often seen in media, Asians often have flatter, wider and poorly defined noses. This visually accentuates the width of the face and the distance between the eyes, making the face look flat and uninteresting.
A high, well-defined nose bridge is sought after and today, non-surgical options for nasal contouring are on the rise, especially among patients that do not wish to undergo rhinoplasty with risks of unfavourable results, downtime and complications such as infection or scarring.
to enhance your nose safely and effectively
Injectable dermal fillers are hydrogels that can be implanted to enhance the shape and contour of the nose. They can be classified into temporary, semi-permanent and permanent fillers. Temporary fillers are most popular and can be classified into 2 broad groups:
- mainly volume replacement - most commonly composed of hyaluronic acid, a naturally occurring glycosaminoglycan polysaccharide which draws and binds water to itself and the surrounding skin. Other examples include agarose or collagen
- collagen stimulating - contain materials such as calcium hydroxyapatite, polycaprolactone that cause the body to produce collagen
Fillers have different structural properties such as cross-linking that manifest in their rheological properties such as viscosity, cohesivity, hardness and resistance to deformity. Hard, cohesive and viscous fillers are preferable for nose augmentation.
Nose threadlift is a more recent nasal augmentation technique. Biocompatible polydioxanone (PDO) surgical threads are implanted in the nasal bridge, tip or columella to improve the shape, height and definition of the nose while stimulating collagen formation to provide sustainable lift. Multiple threads are inserted through a tiny puncture in the nose tip to add volume and height. The volume added is visible after insertion as the threads provide a scaffold for the nose, and the effect can be fine-tuned on the spot. The number of threads required varies according to the individual and needs to be assessed in detail during the consultation.
Nose threadlift technique can be considered an intermediary between nose filler augmentation and surgical rhinoplasty. Unlike nose fillers, where even the hardest filler is not solid, nose threadlift uses solid threads which do not spread sideways. This gives a structural nose bridge similar to surgical nasal implant, with sharper and better defined results compared to filler. The multiple threads stacked together can be as thick as a surgical rhinoplasty implant. However, unlike surgical rhinoplasty, the implant is resorbable and inserted through a tiny puncture with much less trauma.
The effect of nose threadlift lasts approximately 1-2 years. The presence of the threads stimulates new collagen production (neocollagenesis) that may remain even after the nose threadlift has be resorbed. This may produce a partial effect that may be long lasting or even semi-permanent, especially after repeated nose threadlifts.
Neurotoxins inhibit release of acetylcholine at the neuromuscular junction. Treatment of specific overactive muscles causes localized muscle relaxation. In certain patients, neurotoxins can be used to relax certain muscles around the nose to lift the nasal tip and reduce the width of the nose.
dr wan's perspective
Dr Wan performs both nose filler and nose threadlift for nasal augmentation. Either procedure can effectively augment the nose. Neither treatment can be said to be the best in all situations and it is perfectly fine to combine both nose fillers and nose threadlift if necessary to achieve the desired nasal augmentation.
There is a wide range of techniques to do so and Dr Wan usually uses a mix of techniques in most cases to give the most optimal result. An expert injector knows the surgical anatomy of the nose well to be able to enhance it safely, has an in-depth understanding of the tools and materials available, and appreciates the beauty of proportions as well as the craft of tailoring the treatment precisely to suit the individual patient. There is no one size fits all and a successful nose contouring would naturally harmonize and complement your facial features.
Dr Wan would assess your anatomy and recommend the most suitable option according to your preferences, generally:
- for higher bridges, a combination of nose threadlift and nose fillers
for spot corrections, nose fillers
- for bridge or tip definition, nose threadlift
In addition, Dr Wan has his own technique to specifically address problems that standard nose threadlift insertion is unable to tackle well, such as:
- nose tip refinement
- nose tip projection
- nose (alar) base narrowing
- nose tip angle lifting
Dr Wan prefers to use very hard and long lasting hyaluronic acid or agarose fillers as they are reversible with hyalase. Generally, collagen stimulators tend to be hard and last longer than 12 months (common duration of effect for harder hyaluronic acid fillers). However, they are not reversible and this may pose a problem in cases of allergy, malposition or inadvertent injection into a blood vessel.
Newer hyaluronic acids can also give equal or even longer-lasting effects up to 2-3 years. Blunt cannulas must be used where possible to reduce the (low) risk of injection into blood vessels around the nose.
Nose threads usually come pre-loaded on cannulas to be inserted into the nose. There is a variety of different lengths and thickness but these standard sizes may not be most suitable for the nose type and desired result. Overly long threads may have a higher risk of extrusion while overly short threads may not give a smooth result.
Dr Wan always manually customizes the length of the threads before insertion to suit the patient’s nose. While some nose threadlifts involve placing as few as 5 threads and on average 10 threads, Dr Wan would generally place numerous thick threads (at least 20) to best simulate the effect of a surgical rhinoplasty
Nose filler vs nose threadlift
- Softer smoother result more suitable for certain faces and noses
- Blends in better in patients with thin skin
- Better for fine spot corrections such as nasal humps
- Can give a higher nose bridge on profile view
- Easier to adjust or reverse than nose threadlift
- Certain very hard fillers may last longer than nose threadlifts
- Feels more natural to touch
- Narrower, more defined bridge
- Gives a more defined result for nasal tip and projection
- No risk of intra-arterial injection (rare but can lead to blood supply problems to the skin or eye)