Nonsurgical Rhinoplasty: Results from a Retrospective Study of Rino-4-Puntos Technique with Hyaluronic Acid

Background

Nonsurgical rhinoplasty (NSR) utilizing hyaluronic acid (HA) filler injections is increasingly used to address nose shape issues. While refinements have been proposed, the technique lacks standardization.

Objectives

Our study aimed to evaluate the aesthetic outcome, longevity of results, safety, and patient satisfaction with the novel Rino-4-Puntos (R4P) NSR technique.

Methods

This is a retrospective study of consecutive individuals treated with R4P between January 2021 and July 2023. All participants had one of the four indications: rectification of the dorsum (21%), triangulation of the tip (32%), projection (25%), and strengthening of the columella (22%). Each patient received two hyaluronic acid (HA) fillers: one with intermediate G prime (G′) at Points 1–3 and another with high G′ at Point 4, which is further divided into Points 4.1, 4.2, 4.3, and 4.4. The injection points were as follows: P1 (radix, 0.05–0.15 mL, supraperiosteal), P2 (supratip, 0.025 mL, suprachondrial), P3 (tip, 0.15 mL, deep fat), P4 (columella, 0.30 mL, supraperiosteal [4.1], or deep fat [4.2, 4.3, and 4.4]).

Results

Four hundred individuals (n = 284 [71%] females) are included. The mean filler volume used was 0.65 ± 0.17 mL. Injecting small boluses (≤ 0.05 mL) in the midline at deep planes minimized the risk of adverse effects, as no vascular complications occurred. Ninety-three percent of participants considered the overall outcome at least satisfactory (“good,” “very good,” or “excellent”). The treatment effect was maintained for a median of 11 months.

Conclusions

The R4P technique refines NSR by combining enhanced aesthetic outcome, longevity, and safety.

Level of Evidence IV

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