Non-Surgical Rhinoplasty: The Ascending Technique and a 14-Year Retrospective Study of 2130 Cases

Kassir R, Venkataram A, Malek A, Rao D.

PubMed 33216177 Publisher (DOI)Free full text (PMC)

What this paper says

Across 2,130 filler rhinoplasty patients treated from 2006 to 2019 with a bottom up injection sequence, 2 percent had persistent tip redness that recovered, and no skin death or eye complications occurred.

Overview

Filler rhinoplasty is one of the fastest growing cosmetic procedures and the authors state no standard technique exists. Most published methods inject from the top down, mirroring surgical sequence. The authors instead set the tip first and then raise the bridge to meet it, which they call the ascending technique. Records from a 14 year period were reviewed retrospectively.

Sections of note

Retrospective analysis of 2,130 patients treated between 2006 and 2019; journal assigned level of evidence IV.
All patients received hyaluronic acid filler.
Four injection sites were used in ascending order: nasal tip, columellar base, dorsum including the supratip, and radix.
The tip was set to the intended projection and rotation first, then the dorsum was adjusted to match.
Patients were 2,023 female, 95 percent, and 107 male, 5 percent.
Sites injected were tip 95 percent, columella 58 percent, dorsum 83 percent, radix 62 percent.
Sixty two percent, 1,321 patients, repeated the procedure after 1 year.
Two percent had persistent tip redness which recovered; there was no skin necrosis and no eye complications.

What it means for a patient

Because filler only adds volume, the authors argue the tip is easily overprojected if the bridge is built first.
Most patients returned for repeat treatment after a year, indicating the effect is temporary.
The serious complications associated with nasal filler, blocked vessels causing skin death or blindness, did not occur in this series.
Satisfaction was asserted rather than measured with a questionnaire, and there was no comparison technique.

Why this paper matters

This is among the largest published series on filler rhinoplasty and it addresses the absence of a standard injection sequence. The size gives some weight to the safety figures. Whether the ascending order produces better results than top down injection is not tested.

Terms

Non surgical rhinoplasty: reshaping the nose with injectable filler instead of surgery.
Hyaluronic acid filler: an injectable gel that can be dissolved if needed.
Radix: the root of the nose between the eyes.
Supratip: the area of the bridge just above the tip.
Skin necrosis: death of skin from loss of blood supply.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Introduction: Non-surgical rhinoplasty or liquid/filler rhinoplasty is one of the fastest-growing cosmetic procedures worldwide. While several papers have been published on this topic, there has been no standardization of the technique. Most techniques advise injection in a top-down manner, similar to a traditional rhinoplasty. We present our ascending technique performed in 2130 cases. This constitutes one of the largest series published on this subject.

Methods: Patient records were retrospectively analysed from 2006 to 2019. All patients were injected with hyaluronic acid fillers. We employed an ascending approach which consisted of four sites: nasal tip, columellar base, dorsum (including supratip) and radix. The tip was first set at the appropriate projection and rotation and then the dorsum adjusted to meet it.

Results: Since 2006, 2130 patients underwent non-surgical rhinoplasty; 2023 patients were female (95%), and 107 were male (5%). The proportions by site injected were tip 95%, columella 58%, dorsum 83%, radix 62%. Sixty-two percent (1321) repeated the procedure after 1 year. Two percent of patients had persistent tip redness which recovered. There was no skin necrosis or ocular complications.

Conclusions: In non-surgical rhinoplasty, all modifications are being done by pure addition, unlike surgical rhinoplasty. In this scenario, the risk of over-projecting the tip is higher. Hence, we believe it is important to set the tip at the desired projection and size and then raise the dorsum accordingly to match. Our high satisfaction rate over 2130 patients validates the efficacy of this ascending technique.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors - www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).