Nose Thread Lift

What Is a Nose Thread Lift?

A nose thread lift is a non-surgical treatment that aims to lift the nose tip and support the bridge of the nose by placing fine medical threads under the skin. In the medical literature it is also called ‘thread rhinoplasty’. Studies group non-surgical nose treatments into three types: filler injections, thread lifting, and injections of botulinum toxin (a muscle relaxant, often called Botox®). Thread lifting is one of these; it does not replace the others but is a separate method that does a different job.

At its core, the treatment works by the threads creating a line of support in the nose. In a study of 553 patients, treatments with poly-L-lactic acid and polycaprolactone threads were planned on the principles of surgical techniques involving grafts (tissue placed to provide support); the aim was a temporary correction of nose shape problems judged suitable for it. The researchers state clearly that the method is not yet standardised and that, for this reason, outcomes can be variable and short-lived.

No tissue is removed, and the cartilage and bone are not reshaped. What changes is the limited support the threads provide at the nose tip and along the bridge. So what the treatment can and cannot do for you depends on whether your concern is the kind that a small amount of support can change. The number of threads, their length and the entry points are decided by the doctor performing the treatment, based on their assessment.

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What Does ‘Nose Thread Lift’ Mean?

The word ‘lift’ comes from facial treatments: on the face, barbed threads hold sagging tissue and move it upwards. In the nose, the issue is less a mass of sagging tissue and more the position of the nose tip and the line of the bridge; here the thread works more like a supporting strut. A study describing nose treatments with barbed threads notes that in Asian patients a strong support structure is needed to bring the nose tip forward, and that this support has traditionally been built through open incisions in the skin; the researchers used threads for this purpose.

Two main types of thread are described for the nose. In a case report of two patients, polydioxanone (PDO) threads were used in two ways: volumising threads to define the contours of the nose, and barbed threads to adjust the nose tip and the base of the nostrils. Polydioxanone is a material that is also used for stitches to close wounds and is absorbed by the body over time.

At this clinic, ‘thread lift’ is the general name for lifting treatments done with threads; the French Thread Lift is one of the techniques within these methods. The nose treatment is also part of this family; however, because the structure of the nose differs from that of the face, the expectations, limits and risks also differ. You can find thread-lifting treatments for the face on the Facial Thread Lift and French Thread Lift pages.

RELATEDFrench Thread Lift

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Lifting the Nose Tip

In research, the most commonly studied aim of a nose thread lift is to support the nose tip. How far the nose tip projects forward (projection) and how far it turns upwards (rotation) are separate measures. One of the values used to measure rotation is the angle between the nose tip and the upper lip; this is called the nasolabial angle.

The longest experience in this area belongs to a single research group. This group, which reports having performed about 1,200 nose treatments with barbed threads since 2003, measured a significant increase in nose tip projection on side-profile photographs and reported that the effect lasted over an observation period of more than six months. However, in these treatments, grafts prepared from the person’s own fat tissue were also used alongside the threads when volume was needed; so the measured result is not always due to the threads alone.

Smaller and more recent studies paint a more cautious picture. In a prospective study of 10 patients treated with polydioxanone threads (a study planned in advance, with patients followed from the start), the increase in the nasolabial angle was not statistically significant; the researchers stated that threads can be used for small changes. In a pilot study of six patients, placing the threads only in the nasal septum, or in both the septum and the bridge of the nose, gave different results. In short, the change at the nose tip is small and depends on the technique used.

The nose tip is also where problems are concentrated. In a series of seven patients who had further surgery because of problems related to thread treatment, the most common finding was threads at the nose tip that had become visible or worked their way out.

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The Bridge of the Nose and a Nasal Hump

On the bridge of the nose, threads add slight support to the line of the bridge; they do not remove a hump. Volumising threads are used to define the contours of the nose. Their effect on the appearance of a hump, however, is limited and has not been shown consistently in studies.

In the prospective study of 10 patients treated with polydioxanone threads, the patients had come for treatment to reduce the appearance of a nasal hump or to increase the upward turn of the nose tip. In quality-of-life questionnaires completed two weeks later, a significant improvement was reported in satisfaction with the nose and in social and psychological scores; attractiveness scores given by 146 people who rated the photographs without knowing at which stage they had been taken (blinded assessment) also increased. However, the measured reduction in the hump was not statistically significant. In other words, the patients’ perception changed, but the measured change remained uncertain; moreover, follow-up was limited to just two weeks.

The layer in which the thread is placed in the bridge of the nose also matters. A report of three cases that examined the anatomical layers in treatments with volumising threads draws attention to the risks of a thread placed close to the surface. To avoid problems involving blood vessels, the report stresses placing the thread in the deep fat layer beneath the fibromuscular layer (the layer made up of muscle and connective tissue). This is a case report; the recommendation is based on knowledge of anatomy and the authors’ experience.

An unexpected problem on the bridge of the nose has also been reported. In a patient who sought care 12 months after a barbed thread treatment, threads that had not been absorbed had formed a hard lump on the bridge of the nose together with the surrounding tissue, creating a hump-like appearance. Although this was seen in a single case, the fact that threads placed in the bridge of the nose can leave a hump-like appearance is part of the uncertainty in this area.

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How Strong Is the Evidence?

The short answer: limited. What is known about nose thread lifts comes largely from case reports, small case series and the retrospective experience of individual practitioners; a large share of the publications come from Asian countries. No study was found that compared this treatment with filler or surgery by randomly assigning patients to groups.

The size of the studies also shows this: a case report of two patients, a pilot study of six patients, a prospective study of 10 patients. The largest series measuring satisfaction includes 553 patients; in this series, the satisfaction rate was 95% at six months but fell to 62% at one year. Follow-up was done with photographs, while satisfaction was measured by the patients’ own assessment. Such a large fall in satisfaction within a year is an indirect sign that the effect is not permanent.

Even in the abstracts of the few studies that make comparisons, there is no mention of patients being randomly assigned to groups. In a study in which 85 patients were divided into three groups, the thread groups had 9 and 13 patients, and the results are based on patient questionnaires. In the report of two cases, the results were reported to last up to eight months; the researchers stressed that long-term safety and effectiveness need to be investigated.

The picture is no different for thread treatments on the face. Reviews in this field state that, although the method is viewed with hope, no new evidence has been added to support its use, and long-term effectiveness data are lacking. Within this already limited body of data, the nose is an area that has been studied even less.

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Limits of This Treatment

A nose thread lift supports the shape of the nose to a limited extent and only temporarily; it is not a substitute for cosmetic nose surgery. Rhinoplasty (cosmetic nose surgery) changes the structure of the cartilage and bone. In a thread treatment, these structures stay where they are, and only slight support is added on top of them. So the two are not a lighter and a heavier version of the same procedure; they are two separate methods working on different scales.

In practice, this means the following: the nose is not made smaller, and a hump is not removed. Wide nostrils or a wide nasal base are not narrowed. Problems with the internal structure of the nose, such as a deviated septum, are not corrected; breathing complaints are not something this treatment deals with, and if you have such a complaint, it is assessed separately. Expecting a large change in shape from a method used for small changes leads to a mismatch between expectations and results.

How long the effect lasts is uncertain. The largest series also states that results can be variable and short-lived. Researchers who examined 30 patients who sought care for complications write that they do not consider it reasonable to accept the risk of such problems for a short-lived effect, and that they do not recommend threads as a routine method of reshaping the nose. This is an open criticism of the treatment, and it is worth knowing about.

Another limit relates to any surgery you might have in the future. In a study of 29 patients who had further surgery after threads had been placed in their nose, it was reported that inflammatory cells built up around the thread as it dissolved and that connective tissue cells multiplied. The resulting scar tissue can affect the planning and outcome of later surgery. In other words, a temporary treatment can leave lasting traces in the tissue. Your doctor assesses you; the decision is yours.

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How It Differs from Nose Filler

Nose filler adds volume at a specific point; a nose thread lift, by contrast, builds support at the nose tip and along the bridge using threads. Both may be considered for the same concern, but they differ in the material used, reversibility and risks.

Filler, thread lifting and botulinum toxin are regarded as separate methods. Some researchers argue that the contours of the nose can be shaped more precisely when volumising threads are used together with filler; however, this view is based on experience with their own patients, not on a comparative study. Combined techniques that use hyaluronic acid filler and polydioxanone threads together are also counted among recent developments in this field.

The two methods differ clearly in terms of reversibility. Hyaluronic acid filler can be dissolved with an enzyme called hyaluronidase. A thread, on the other hand, is removed surgically when necessary: in a study of patients who had further surgery because of problems, removing the threads required careful dissection of the tissue and led to a loss of support at the nose tip. That said, filler has its own serious risks, particularly the risk of vascular occlusion (a blocked blood vessel); you can find details of these on the Nose Filler page.

There are also studies in which all three methods are used together. In a study of 85 patients, satisfaction scores were higher in the group treated with threads, filler and botulinum toxin together; however, the abstract of this study does not mention patients being randomly assigned to groups, and the results are based on patient questionnaires. Which method may be considered for you, in what order, or which ones may be combined is decided at your consultation.

RELATEDNose Filler

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Dissolvable Versus Permanent Threads

The main difference that determines what happens in the long term is whether the threads used in the nose are dissolvable or permanent. Dissolvable threads are made of materials that break down over time, such as polydioxanone, poly-L-lactic acid or polycaprolactone; permanent threads do not dissolve and remain in the tissue. The clinic uses dissolvable threads (PLLA/PDO).

Warnings about permanent threads come from cases that emerged years later. Ten years after their nose was shaped with permanent lifting threads, one patient developed asymmetry of the nose, difficulty breathing and a feeling of a foreign body inside the nose. During surgery, the thread was found to be moving outwards, a granuloma (a cluster of inflamed tissue that the body forms in reaction to a foreign body) had developed around it, and one of the cartilages of the nostril had been partly torn. In another patient, who developed an inflammatory lump in the nasal septum ten years after a barbed thread treatment, threads were also found inside the lump; the abstract of the publication does not state what type of thread was used in this case.

Dissolvable threads are not completely free of these risks either. Researchers who examined seven patients who sought care for infection after polydioxanone threads reported that this thread is usually absorbed after six months, but that it cannot be seen on imaging and can lead to severe infections. In a publication comparing two cases, one treated with a dissolvable thread and one with a non-dissolvable thread, a foreign-body granuloma was found in both; the condition was reported to be more severe with the dissolvable thread. However, this is an observation based on only two cases.

In the series of seven patients who had further surgery because of problems, the threads were found unabsorbed and still intact even years after they had been placed; the abstract of the publication does not state what material the threads were made of. So if you have had threads placed in your nose before, the type of thread and the records of that treatment are among the information you will be asked about at your consultation.

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Known Risks

Problems reported after a nose thread lift are divided into early and late problems. Temporary side effects can occur in the early period. In the later period, visible threads or threads working their way out, infection, skin dimpling, granuloma and distortion of the shape of the nose have been reported. Some late problems require the thread to be removed.

Reported problems include threads working their way out through the skin or through the oral mucosa (the membrane lining the inside of the mouth), threads moving out of place or becoming visible, skin infections, dimpling and granuloma formation. Early treatment of these problems is emphasised to reduce the risk of serious outcomes. In a study of 85 patients, all side effects reported 48 hours after the procedure had resolved within one week.

In a series of 30 patients who sought care for complications, the most common reason for seeking care was infection (46.7%), followed by thread extrusion (30%), persistent inflammation (16.7%) and dimpling (6.7%). This study states that infection always required the thread to be removed. These percentages do not show how often these problems occur in everyone who has threads; they show the distribution among those who sought care for complications.

Of seven patients who sought care for infection after polydioxanone threads, three developed open wounds, abscesses and skin necrosis (death of skin tissue); six of these seven patients had previously had nose surgery. In the series of 29 patients who wanted further surgery, the following were reported: insufficient projection of the nose tip and root, exposed threads, infection and, in three patients, a shift of the columella (the strip of tissue that separates the two nostrils) to one side.

Large studies that report combined rates, however, relate to facial treatments. In an analysis combining the results of 26 studies (meta-analysis), swelling was reported in 34%, bruising in 26%, and visible or palpable threads (threads you can see or feel under the skin) in 10%. A review of dissolvable threads also states that barbed threads are linked to more problems than smooth threads. However, these figures cannot be applied directly to the nose.

RELATEDWhat to look out for after a thread lift

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Can It Be Reversed? Thread Removal and Later Surgery

A thread can be removed if necessary, but this is not always a simple procedure. Unlike hyaluronic acid filler, a thread cannot be dissolved with an enzyme; finding and removing the thread requires a surgical procedure. How easily it can be removed depends on how long the thread has been in the tissue and what has developed around it.

The study of 30 patients who sought care for complications reported that threads could be completely removed within the first month after treatment. In the same study, ultrasound helped to detect remaining threads and to identify the area of infection. The study of patients who sought care for infection after polydioxanone threads noted that when infection is severe, extensive cleaning of the area and removal of any previously placed implant may be needed; the researchers recommended that this treatment should not be done in people who have an implant in the nose.

Later on, the situation changes. In the series of seven patients who had further surgery, removing threads from the nose tip and bridge required careful dissection of the tissue; the support of the nose tip was weakened, and irregularities and partial tissue loss developed on the bridge of the nose. Grafts taken from the person’s own tissue were needed to rebuild the support. In other words, removing the thread may not return the nose to the way it was before the treatment.

This is important to know if you are considering cosmetic nose surgery in the future. The study of 29 patients who had further surgery reported that the thread formed scar tissue around it as it dissolved, and that this affected the planning and outcome of the later surgery; in 26 of these patients, the nose tip was reshaped using rib or septal cartilage. For this reason, a decision about a nose thread lift should also take possible future surgery into account.

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Why Do Treatment Conditions Matter?

Problems seen after a nose thread lift have been reported to be linked to who performed the treatment and under what conditions. In the series of 30 patients who sought care for complications, 70% had had the treatment in non-medical places without legal authorisation. This figure shows only the distribution among those who sought care for complications. This points to the importance of the conditions in which the treatment is performed; however, having the treatment in a medical setting does not remove the risk.

In a study of 190 patients who sought care after facial thread treatments, the main causes of problems were given as insufficient knowledge of facial anatomy and inexperienced practice. A similar point is made for the nose: placing the thread in the correct layer is seen as a condition for reducing the risk of blood vessel injury, and the risks of a thread placed close to the surface are also highlighted.

Before the procedure, you will be asked about blood thinners, antiplatelet medicines (which stop platelets from clumping together) and supplements that can affect bleeding. Do not stop any prescribed medicine on your own. If needed, the procedure is planned or postponed after consulting the relevant doctor. This is a general safety step; the specific approach for this treatment is planned with you at your consultation.

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