Nose threadlifts are getting really popular in Singapore. I’ve had to extend closing hours twice over the past week to accommodate patients doing nose threadlifts.

Unfortunately, many patients in Singapore aren’t born with the high, well- defined nose bridge that they desire. Our genetics tend towards shorter and flatter nose bridges with broader and less defined nose tips. It’s a pity because a well-proportioned nose really adds a touch of elegance. An added bonus is that it visually slims the face - A flat nose can make a broad face look even wider!

Over the years, I’ve treated many patients with non-surgical nose contouring. These patients are not keen on going under the knife for various reasons. They prefer a simple and quick office procedure without the risks of scarring and prolonged recovery.

Previously, the only option was nose fillers but in recent years, nose threadlifts have entered the mainstream consciousness. Nowadays, I get more enquiries for nose threadlifts than nose fillers.

Some patients come fixated on the idea that nose fillers are passé and that nose threadlifts are the only way to go. They may have gotten this notion from reading articles online or after consulting with other aesthetics doctors.

Are nose threadlifts really better than nose fillers though?

Aren’t Nose Threadlifts Recommended By Most Doctors Over Nose Fillers?

Since the introduction of nose threadlifts, there has been a trend for doctors to recommend nose threadlifts over nose fillers.

Why is this so?

A few years ago, there was a case of blindness due to injection of nose filler. Many doctors’ kneejerk reaction was to stop doing nose fillers out of fear. Even today, many doctors persist in not doing nose fillers instead of using proper technique to manage the risks.

Furthermore, previously available fillers were not hard enough leading to spreading and widening of the nose bridge after injection, the so-called ‘avatar nose’. Typical offenders were actually well-known brands fillers like J, R etc.

Tip: There are quite a few techniques to reduce fillers risks to a minimum. Ask your doctor how he mitigates the risks of nose fillers.

For enhancing the nose bridge, these advantages still stand. Done right, a nose threadlift has the following advantages:

• A natural feel: Even the hardest filler is a gel, and after injection feels firm, whereas nose threads feel hard, more like a real nose
• No risk of vascular injury: This is a big relief for both doctor and patient.
• Narrower, more defined nose bridge: Particularly good for patients who have a narrow nose bridge

The results of threadlifts for nose bridges can be amazingly close to that of nose implants, provided a sufficient number (20-30) of suitably thick threads are inserted.

Many times, patients are fixated on the prices of nose threadlifts (I’ve seen super low prices). But like most things, you get what you pay for. Cheap nose threadlifts may only involve the insertion of a few standard length threads (typically fewer than 10). This is fast, easy and doesn’t cost much for the doctor but only highlights the nose bridge without a significant increase in height. Read more about the various types of nose threads.

A proper complete nose threadlift in Singapore would cost between 1200 and 1800 and give an appreciable and visible lift to the nose bridge in comparison to 'nose threadlifts' that may cost less than 1000.

Some clinics in Singapore are known to reuse unfinished fillers and threads. Of course, using leftover fillers and threads is much cheaper as the material can be shared between patients leading to lower costs. Would you want to use someone else's leftovers?

Some patients don't mind, but personally, I feel that such practices are exposing them to complications such as bacterial contamination and transmission of infectious diseases. I do not reuse unfinished fillers and threads between patients. Once unsealed from the sterile vacuum package, the fresh fillers or threads need to be used immediately and any balance will be discarded. This ensures that patients get the freshest product and minimizes taking unnecessary risks.

Tip: Ask your doctor how many threads he will be inserting, what size and where

So Nose Threadlift IS Actually Recommended Over Fillers?

Not quite.

Like most things in life, it really depends.

Nose threadlifts are great for making the nose bridge higher in most cases but can have problems of their own.

Many of these problems stem from technique issues:

1. trying to use nose threadlifts to do spot enhancement especially nose tip projection
2. relying on standard threads without customization

Nose threads actually come from the supplier in standard thicknesses and lengths, pre-mounted on insertion cannulas. Many doctors would use these without further customization to the patient’s nose structure. Why? Because it is much faster. Customizing the threads takes a lot of time:

• First, the threads have to be removed from the cannula one by one
• A probe is inserted via entry point puncture at the nose tip to measure your nose structure
• The threads are customized to the correct lengths for various parts of the nose structure
• The customized threads are re-mounted individually on to the cannulas for insertion

Compared to just inserting standard threads, customization takes more than twice the time. Precious time which the doctor could spend attending to other patients or procedures.

Tip: Ask your doctor if he will customize all the threads BEFORE insertion

Why spend so much time customizing? Why not just use standard sized threads?

Standard sized threads can sometimes work well without customizing - if you happen to have a standard size nose or something very close. Other times, standard size threads may lead to problems:

• Too short - May lead to a "step-off" over the nose bridge or nose tip, that can be felt or even seen sometimes
• Too long - May lead to a curved or crooked bridge if pushed all the way in (too high up). May increase the risk of thread protrusion through the nose tip if not pushed all the way in

Tip: Always ask your doctor if the threads are customized to your nose structure

Nose threadlift pitfalls

Now, with the advent of nose threadlifts, many doctors have tried to use the technique in other areas such as to do spot corrections (e.g. correct hooked noses), to sharpen the nose tip, and to increase the nasal tip projection. While nose threadlifts can be used for these areas, it can sometimes give rise to problems:

• Misalignment - Short threads are more prone to shifting, and as the threads are solid it is difficult to really mould a smooth contour for spot corrections to blend into the surrounding tissue
• Extrusion - Short threads used in the columella to sharpen the nose tip and increase nasal tip projection aim to emulate the effect of the columellar strut in a nasal implant - but even in silicone implants, there is a risk of the implant extruding through the skin due to pressure on the overlying skin. As the threads are much thinner than implants, the pressure is much greater and thus there is a higher risk of thread extrusion. If the thread is not carefully placed to follow the curve of the nose tip, the tip of the thread pushes against the thin skin below the nose tip instead of the thicker skin of the nose tip itself, increasing the risk further
• Persistent pain - The ends of the threads can also exert pressure on the surrounding tissues leading to persistent pain or sensitivity. I have seen quite a few of these cases. Areas affected commonly would be the nose tip, the base of the columella, nasal spine or upper gums, particularly if the threads are too long or the placement abuts against an area of thin skin

Tip: Ask your doctor if he is skilled enough to remove the threads if anything goes wrong. Many doctors will tell you that nose threads, once inserted, are not removable. Not true!

When Are Fillers Better Than Nose Threadlifts?

Patients can sometimes be over-fixated on the height of their nose bridge. In fact, much more attention needs to be paid to the overall balance of the nose and whether it fits in harmoniously with the face. A high nose bridge with a flat bulbous tip would look weird.

I’ve found that the right filler and technique can work great at sharpening the nose tip and increasing projection. Certainly, in my experience, it is much easier to obtain a great result for nose tip with nose fillers compared to nose threadlifts. While injectables like fillers and threadlifts only add volume but cannot remove any tissue, the strategic placement of small amounts of filler in the nose tip and columella can actually make the nose appear sharper and more pointy.

The overall result is much more elegant and pleasing.

Another area that fillers are preferable over nose threadlifts is spot corrections. Fillers are gels and thus easily moldable to fill irregular defects. They also blend seamlessly into the surrounding tissues.

Lastly, fillers may be better than threads when the skin is very thin. As nose threads are solid, the contours of the threads may be visible under thin skin. With no obvious hard borders, fillers would perform better for thin skin.

Tip: Ask your doctor why he recommends a particular technique for your nose. A doctor that knows his stuff wouldn't mind explaining in a little more detail.

Bear in mind, however, that not all fillers are the same. Fillers vary in their physical properties such as hardness, viscosity, cohesivity and longevity. Cheap fillers advertised online might look tempting but are often shared between patients or of poorer quality. Conversely, certain brands might be very well known, but when used in the nose yield relatively poorer results. An experienced doctor should have broad knowledge and experience with various ranges of fillers and their effects, enabling him to choose the most suitable filler.

Which Should You Choose?

Nose threadlift and nose fillers can both produce superb results. While some patients will still require rhinoplasty, the large majority can have surprisingly good results with filler or nose threadlifts without undergoing surgery.

The aim is to highlight your facial features in a natural and harmonious way. It's definitely not a case of the more the better! A nose that is overly high, too sharp or unbalanced would look strange. Instead, most patients want to have a nice looking nose that complements their features, to make them prettier or more handsome yet without standing out too much from the rest of their features.

A successful non-surgical nose contouring, whether using nose threadlift or filler, should be able to accomplish just that. Your friends will notice that you somehow look more attractive but not in such a way that they can spot exactly what was done.

Don’t be too set on a particular method of non-surgical nose contouring. Find a doctor you can trust and listen to his opinion. Some patients tell me that they tell their doctor where they want the filler or threads and even how much they require, and the doctor does exactly what they want.

Wouldn’t it make more sense to let the doctor with years of actual practical experience advise you on what's the best approach? Sometimes patients (who may have had many nose fillers or threads before) are pleasantly surprised because my technique and the corresponding results are quite different from what other many doctors did for them in the past.

Ultimately, it is not about the tools - it's about how the tools are used. Careful analysis, a thorough understanding of the nose structure and nuanced appreciation of beautiful facial proportions is fundamental. In-depth experience with a broad range of techniques and familiarity with how to best use each technique is much more important for a good result.

Do you have more questions about nose threadlifts or fillers? Did I miss anything? Let me know!

References

1. Jang YJ, Alfanta EM. Rhinoplasty in the Asian nose. Facial Plast Surg Clin North Am. 2014 Aug;22(3):357-77.
2. Wang LL et al. Update on injectables in the nose. Curr Opin Otolaryngol Head Neck Surg. August 2017.
3. Thomas WW et al. Injectables in the Nose: Facts and Controversies. Facial Plast Surg Clin North Am. (2016)