Drawbacks and Limitations of Thread Rhinoplasty

Nonsurgical rhinoplasty using barbed threads has gained popularity in Asia as a result of being viewed as a minimally invasive procedure that is relatively inexpensive with a short recovery period and minimal complications. Usually, absorbable polydioxanone thread is used, but nonabsorbable thread is also sometimes used. When inserted, multiple barbs along the threads hook into the tissue, causing traction or stretching. Although minor tip projection or dorsal lengthening can be obtained simply using this procedure, it is difficult to increase volume sufficiently; therefore, the procedure is often combined with filler injection or fat grafting. However, the long-term benefit is questionable, since the filler is absorbed and fat is also partially absorbed over time.

Anatomically, the East Asian nose is characterized by thick skin, poor tip definition, and a low radix. Compared with the Caucasian nose, it tends to be relatively small, low, and flat, resulting in demand for augmentation rhinoplasty. Minor changes can be obtained using thread rhinoplasty, but it is difficult to achieve significant tip projection, improved tip definition, or dorsal augmentation. To compensate for the insufficient increase in volume or support using threads alone, too many threads may be inserted or the procedure may be repeated several times, which can lead to complications such as infection. In severe cases, abscess formation with an open wound and skin necrosis can occur. Thread extrusion (▶ [Fig. 1A]), chronic inflammation, dimpling, and irritation are also not uncommon complications. Aesthetic dissatisfaction is often encountered in clinical practice.

Fig. 1 A 38-year-old male patient underwent revision rhinoplasty with thread removal following complications after thread rhinoplasty. (A) Before revision rhinoplasty, thread extrusion was observed at the nasal tip. (B) After skin-flap elevation, the barbed threads in the tip were exposed. (C) The threads were removed by careful dissection. Some adhering soft tissue was inevitably removed during thread removal. (D) Removed threads. (E) At 2 years after surgery, a scar remained.

To resolve these complications, revision rhinoplasty is required, and all inserted threads must be surgically removed (▶ [Fig. 1B]). However, barbed threads cannot easily be removed by simply pulling them out; they must be carefully removed by dissection along the path into which they were inserted (▶ [Fig. 1C]). Inevitably, some surrounding tissue adhering to the barbs is removed during thread removal (▶ [Fig. 1D]). The barbs that adhered the thread firmly to the tissue on insertion make it difficult to remove. Thread removal results in eventual loss of structural support and dorsal irregularity, causing an appearance that is aesthetically worse than before the procedure. In addition, if the threads extruded from the skin, permanent scarring may remain (▶ [Fig. 1E]).

Thus, thread rhinoplasty lacks the merits claimed by the developer and producer; no significant change can be expected, and it may result in complications. Furthermore, the overall aesthetic performance of thread rhinoplasty is far inferior to typical injection rhinoplasty using filler. We are skeptical of any role for thread rhinoplasty for the Asian nose.

Editor-in-Chief Comment: We thank the authors for bringing this trend to our attention, and publish their Letter with additional photo documentation to assist other facial plastic surgeons who may encounter this problem.

Publication History

Article published online:
24 March 2023