Due to the low potential risks and narrow margin for error, non-surgical rhinoplasty has become one of the most popular aesthetic procedures among practitioners and patients. As with liquid facelifts or a thread lifts, non-surgical rhinoplasty (NSR) is not designed to replace a surgical procedure. Regardless, non-surgical rhinoplasty can be used as an adjunctive treatment in combination to conventional surgical procedures or on its own for minor concerns. It is often indicated for the correction of minor deformities, e.g. asymmetry, prominent hump, and saddle nose. In the hands of the right practitioner, non-surgical rhinoplasty can deliver excellent treatment results. As with all other aesthetic procedures, practitioners should be aware of the contraindications and limitations of non-surgical rhinoplasty. At the same time, it is important to learn about the pitfalls and risks associated with non-surgical rhinoplasty.

In this article, we will discuss the protocol of using hyaluronic acid-based dermal fillers in non-surgical rhinoplasty (in particular, the method of injecting into the 3 major areas, which is known as the three-point Rhino). The three-point rhino is a standardized and rationalized three-point method of using hyaluronic acid-based fillers to perform a non-surgical rhinoplasty. Being trademarked, the technique is reliable, effective and safe. The patented method also helps to reduce the risks of scarring and swelling. It also prevents inconsistency in treatment results.

What is the three-point Rhino?

The three-point Rhino is a rationalized, systematic approach of addressing common anatomical characteristics in patients seeking rhinoplasty. For example, inadequate projection of the tip, dorsal hump and low radix are the most common concerns of patients looking for non-surgical rhinoplasty. Other complaints (which are less common) can be treated as needed.

Through technique refinement and experience, it is possible to simplify and rationalize non-surgical rhinoplasty into the three-point approach, which works for most patients. Currently, the three-point Rhino has been used on over 140 patients with reliable, satisfactory and consistent results.

For a number of reasons, NSR is beneficial for both practitioners and patients. From the perspective of a practitioner, the three-step corrective procedure is a relatively simple way of rationalizing the examination and subsequent treatments of nasal deformities. This eliminates the need for consecutive refinements or excessive injections, which are common for other inject-as-you-go or systematic approaches. These approaches have a higher tendency to cause swelling and inaccuracies. Besides, they often involve lengthy procedures, which can cause discomfort to patients.

From the perspective of a patient, the in-office procedure is virtually pain-free and associated with minimal risks. Plus, the procedure only takes 15 minutes to complete. Non-surgical rhinoplasty is able to deliver instant results without any downtime. The treatment is not likely to leave any scars and does not require the use of an anesthetic. For patients who are unable to undergo surgical rhinoplasty (due to personal or medical reasons), non-surgical rhinoplasty is the ideal method of achieving the desired nasal correction.

In addition, this technique is suitable for patients contemplating a surgery. Before undergoing a surgery (which is oftentimes pricy and risky), non-rhinoplasty allows patients to see how a corrected nose might appear.
By addressing the major anatomical areas, the rationalized three-point Rhino approach serves as a good template for the treatment of common nasal complaints. In addition, it offers a reliable template for novice practitioners (which can be adapted and modified later for the treatment of complex cases of nose deformities).

Techniques of non-surgical rhinoplasty

After consulting the patient (and obtaining written consent), prepare the patient in the treatment suite. Mark the injection sites and the three anatomical points at the radix (either side of the tip and dorsal hump). Practitioners may apply topical anesthetic as needed.

In order to eliminate the need for an extra anesthetic before injection, it is recommended to use a hyaluronic acid with lidocaine. Ideally, the hyaluronic acid in the filler should be cross-linked and viscous. This will offer better volumizing results and durability. Using an extra anesthetic pre-injection may mask and distort the fine nasal discrepancies.

Practitioners should keep the number of penetration points to a minimum, and perform the injection using the least traumatic method possible. The three-point method does not refer to the number of injections performed, but the three fundamental anatomical sites on the nose. If the correction is not sufficient, the doctor may need to repeat the injection at the same treatment site.

As with all other surgeries, the principle of non-surgical rhinoplasty is to inflict as little soft tissue damage as possible, so that there will be minimal scarring, swelling and pain. Therefore, it is recommended to inject directly at discrete points using a needle. The first injection point is located at the radix. Injecting into this area helps elevate the lift off point of the nose. This gives the nose more aesthetic balance, while blending in an hourglass curve with the eyebrows. The second injection should be performed at the nasal dorsum to mask any visible depression or dorsal hump. Performed on the nasal tip, the third injection gives the illusion of a greater lift and improves the light reflection points at the nose tip. The injection points will be discussed in depth in the following section.

While performing non-surgical rhinoplasty, practitioners are advised to use an inert hyaluronic acid filler with a low swelling profile. This helps to minimize tissue reactions. When injecting into the nose, it is not advisable to use a bioactive, semi-permanent filler or non-hyaluronic acid collagen stimulators. These fillers tend to increase the formation of collagen and scarring. For this particular technique, practitioners may use a needle to inject into the critical points directly. Some cases (e.g. correction of a deviation) may require the use of a cannula. In order to minimize the amount of potential scarring and trauma to the soft tissue of the nasal dorsum (and repetitive burrowing under the skin), it is not recommended to use overzealous cannula techniques.

To ensure natural results and minimal recovery time and swelling, doctors should avoid interfering with the natural anatomy of the nose. Some factors may lead to excessive bruising and tissue edema. Some of these factors include injection of low quality hyaluronic acid fillers, crude injection technique, repetitive refinement, and the use of multiple injection points. These factors may make it more difficult to fine tune the procedure and predict the results.

While performing non-surgical rhinoplasty, practitioners should minimize the amount of trauma to the local tissue in order to decrease scarring. This is especially important for patients who are considering a surgical rhinoplasty, as excessive scarring and disrupted tissue planes can make it more difficult to carry out the operation. In contrast to other techniques, the three-point Rhino is able to overcome the previously mentioned barriers while simplifying the steps to just three injections at critical points. In most patients, the technique has yielded aesthetically pleasing, natural results.

The three injection points

The radix – point one

The hyaluronic acid filler should be administered into the bony dorsum and radix. Then, massage into a fan shape. The aim of the first injection is to elevate the level of the radix to the upper lash line to reduce the look of a bottom-heavy, curved nose for a better proportion. The fan shape accentuates the gentle hour glass curvature from the eyebrow to the nose. Inject slightly more cautiously in this area if the dorsal hump is very prominent.

The dorsum – point two

Inject a small bolus of hyaluronic acid filler caudally to the prominent dorsal hump. Massage the injected hyaluronic acid bolus carefully to smooth any irregularities on the dorsum and minimize the look of the dorsal hump.

The tip – point three

Lastly, inject a small amount of hyaluronic acid into the two light reflection points of the nose tip. Depending on the shape of the nasal tip (and how the soft tissues respond to the dermal filler injection), the needed volume ranges from 0.05ml to 0.1ml. The injection at this area slightly raises the tip, creating a mild supra-tip which is more aesthetically pleasing than a straight profile (especially in women).

Who is the ideal patient for non-surgical rhinoplasty?

Being highly versatile, the three-point Rhino is suitable for most patients. When it comes to non-surgical rhinoplasty, patients should have realistic expectations and achievable treatment goals. The ideal candidate for non-surgical techniques e.g. the three-point Rhino method should have a nose with deficient tip projection, low radix and gentle dorsal hump and convexity. Prior to treatment, patients should be aware that the nose will become bigger (albeit not obvious) if additional volume is added.

After a non-surgical rhinoplasty, the tip will be lifted, and the profile straightened. Plus, the proportion and balance will be significantly improved.

What are the expected results of a non-surgical rhinoplasty?

The results of the three-pint Rhino method are repeatable and extremely reliable, provided that patients are chosen appropriately. To ensure optimal treatment outcomes, practitioners should respect the normal anatomy of the nose while minimizing any interference. In addition, doctors should use a small amount of high-quality hyaluronic acid dermal fillers. Typically, the volume required ranges between 0.6ml to 1ml.

The longevity of the results varies depending on the type of dermal filler and several other patient-related factors. This includes metabolic rate and physical activity. In most cases, the results of the three-point Rhino (and other non-surgical rhinoplasty techniques) can last nine to 12 months, provided that the appropriate hyaluronic acid filler is used.

Complications and side effects associated with non-surgical rhinoplasty

Non-surgical rhinoplasty, as with any other aesthetic procedures, can potentially cause complications and side effects. For instance, the circulation may be compromised if the skin is subjected to excessive tension. In patients who would have been better suited for rhinoplasty, extensive changes may lead to abnormal nasal contours. Other than that, large volumes of filler boluses can be palpable or visible.

In general, the palpability and visibility of fillers can be minimized by massaging the injection area gently. In contrast to non-hyaluronic acid formulations, the complications of hyaluronic acid fillers can be easily treated using hyaluronidase.

To minimize the risk of bruising, it is recommended to apply firm pressure to the injection points.

During a non-surgical rhinoplasty, a sterile injection technique should be employed. At the same time, doctors should keep the number of injections to a minimum. It is also important to have a good knowledge of the anatomy of the nose. In addition, doctors should be familiar with the nasal vascular anatomy.

Conclusion

The three-point Rhino is a rationalized and simplified way of treating common anatomical features in patients with insufficient tip projection, dorsal hump and a low radix. The highly versatile technique has been shown to be highly reliable, producing aesthetically pleasing, consistent results. It also helps to reduce the risks of scarring and swelling. Plus, the three-point Rhino method is not known to inflict significant trauma to the natural nasal anatomy. The first injection point is on the radix, whereas the second injection is to be performed on the dorsum. The last injection should be administered into the tip. While suitable for most patients, non-surgical rhinoplasty is contraindicated in some individuals (for example, pregnant patients or those who are allergic to dermal fillers). To ensure treatment success, practitioners should screen the patients carefully, and refuse treatments whenever appropriate. In particular, doctors should not perform non-surgical rhinoplasty on patients who have overly high expectations. Prior to treatment, patients should be made aware of all potential side effects and complications associated with non-surgical rhinoplasty. Doctors should only proceed with the treatment if patients find the risks accepted and express consent in writing.