Nonsurgical Rhinoplasty: A Breakthrough with the Rino-4-Puntos Technique
Introduction
Nonsurgical rhinoplasty (NSR) using hyaluronic acid (HA) fillers has become an increasingly popular alternative to traditional surgical rhinoplasty. The technique offers immediate aesthetic improvements with minimal downtime, making it an attractive option for patients seeking nasal refinement. However, standardization remains a challenge. A recent retrospective study explores the efficacy, safety, and longevity of the Rino-4-Puntos (R4P) technique, a novel approach designed to enhance precision and safety.
Study Overview
This study, conducted from January 2021 to July 2023, analyzed 400 patients who underwent NSR with the R4P technique. The patient demographic included 71% females, with ages ranging from 18 to 86 years. The primary concerns addressed included nasal dorsum rectification (21%), tip triangulation (32%), projection enhancement (25%), and columella strengthening (22%) [1].
The Rino-4-Puntos Technique
Unlike traditional filler techniques, R4P involves precise injection at four critical nasal points:
- Point 1 (Radix): Injected at the supraperiosteal level (0.05-0.15 mL) to improve dorsum contour.
- Point 2 (Supratip): Small bolus (0.025 mL) at the suprachondrial level to correct nasal hump.
- Point 3 (Tip): Injected into deep fat (0.15 mL) to refine tip shape and enhance triangulation.
- Point 4 (Columella): Divided into four sub-points, injecting high G′ HA (0.30 mL) for structural support and improved nasal tip projection [1].
Diagram illustrating the four injection points.
Key Findings
- Patient Satisfaction: 93% of patients rated the results as “good,” “very good,” or “excellent.”
- Longevity of Results: The median duration of aesthetic improvement was 11 months.
- Safety Profile: No vascular complications were reported, attributed to midline injections, use of small boluses (≤ 0.05 mL), and deep-plane placement.
- Filler Volume: The mean filler volume used per patient was 0.65 ± 0.17 mL, with male patients requiring slightly more due to thicker nasal skin [1].
Suggested Table:
| Parameter | Value |
|---|---|
| Patients (n) | 400 |
| Female (%) | 71% |
| Mean Filler Volume (mL) | 0.65 ± 0.17 |
| Longevity (months) | 11 |
| Satisfaction (%) | 93% |
| Complications (%) | 0% |
Comparison with Other NSR Techniques
R4P stands out due to its use of two distinct HA fillers:
- Intermediate G′ HA for dorsum and tip, ensuring smooth contouring and refined projection.
- High G′ HA for columella, providing rigidity and longer-lasting results.
Additionally, unlike other techniques that inject at the nasal tip periphery, R4P maintains a midline approach, minimizing vascular risks. The study suggests that the 45° injection angle at Point 3 optimally elevates and retracts the nasal tip without excessive feminization in male patients [1].
Safety Considerations
The study reinforces best practices for preventing vascular complications:
- Always inject in the midline to avoid lateral vascular networks.
- Perform slow, small-volume injections (≤ 0.05 mL) with prior aspiration.
- Use a 27-gauge needle for better control and reduced vascular entry risk.
- Monitor vascular refill time (< 4 seconds post-injection) to detect early ischemic signs [1].
Conclusion
The R4P technique represents a significant advancement in NSR, offering superior aesthetic outcomes, prolonged effect duration, and an improved safety profile. This standardized, evidence-based approach provides plastic surgeons with a refined method for nonsurgical nasal enhancement.
Future studies, particularly randomized controlled trials, are needed to further validate these findings across diverse patient populations. Nonetheless, R4P presents an exciting, minimally invasive alternative to traditional rhinoplasty with excellent patient satisfaction and low complication rates.
References
[1] Silikovich, F., & Kroumpouzos, G. (2024). Nonsurgical Rhinoplasty: Results from a Retrospective Study of Rino-4-Puntos Technique with Hyaluronic Acid. Aesthetic Plastic Surgery, 49, 672-682. https://doi.org/10.1007/s00266-024-04263-z
Here is the updated version of the 12 FAQs with all mentions of “R4P” and other branded names replaced by the general term “nonsurgical rhinoplasty” to ensure clarity and consistency for patient-facing content:
Patient FAQs about Nonsurgical Rhinoplasty
- What is nonsurgical rhinoplasty?
Nonsurgical rhinoplasty is a minimally invasive procedure that reshapes the nose using injectable hyaluronic acid (HA) fillers—no surgery, no downtime. - How is this technique different from traditional nose filler procedures?
This method uses small, precise injections at key midline points using HA fillers with different properties to achieve safer, longer-lasting, and more natural-looking results. - Who is an ideal candidate for nonsurgical rhinoplasty?
Ideal candidates are individuals looking to enhance the nose shape—correcting humps, refining the tip, or improving projection—without undergoing surgery. - What can I expect during the procedure?
The treatment takes about 15–20 minutes. It involves small needle injections with minimal discomfort and no need for anesthesia. You can resume daily activities right after. - How long do the results last?
Results typically last around 11 months. Depending on your skin, filler type, and lifestyle, some results may last even longer. - Is the procedure painful?
Most patients experience mild discomfort. The use of lidocaine-containing fillers and a skilled injector ensures the procedure is generally well-tolerated. - Are there any risks or side effects?
Minor redness or swelling may occur and usually resolves within 72 hours. Vascular complications are rare when performed by trained professionals using correct techniques. - Can nonsurgical rhinoplasty make my nose appear smaller?
Yes. Although fillers add volume, better contouring and definition often create the appearance of a slimmer, more balanced nose. - How soon can I return to work or regular activities?
Immediately. Most patients continue with their day as usual, though it’s advised to avoid heavy exercise or pressure on the nose for 24–48 hours. - Can I still undergo the procedure if I’ve had nose surgery before?
It depends. Prior nasal surgery may alter blood vessels and tissue planes, so a consultation is necessary to assess safety and feasibility. - How can I maintain results long-term?
Most patients benefit from maintenance sessions once a year. Sun protection, hydration, and avoiding smoking can also help preserve the results. - Is this technique suitable for both men and women?
Absolutely. The injection technique can be adapted for anatomical differences, with slightly more filler used for men due to thicker nasal skin.