The Use of Cross-Linked Hyaluronic Acid in Non-surgical Rhinoplasty Using Italian Technique

Scarano A, Sbarbati A, Amuso D, Amore R, Tari SR, Alla I.

PubMed 38942953 Publisher (DOI)Free full text (PMC)

What this paper says

In 140 adults with drooping or under-projected tips, two filler injections (one at the columella base for rotation, one above for projection) improved GAIS by at least 2-3 grades, with measurements stable from 90 to 180 days and no adverse events.

Overview

The tip is the most important nasal feature in rejuvenation. The Italian authors treated 140 patients (95 women, 45 men; mean age 44, range 31-52) between November 2019 and 2023, 118 with age-related tip drooping and 22 with congenital under-projection, using a cross-linked hyaluronic acid product (Neofound STRUCT LIDO) via two access points. Outcomes were GAIS and anthropometric measurements at baseline, 90 and 180 days.

Sections of note

140 patients; mean age 44 (SD 5).
Two injections: antero-caudal over the columella for upward rotation; antero-superior for projection.
All subjects improved at least 2-3 GAIS grades.
Significant morphometric change from baseline to 90 days (p < 0.0001); no change between 90 and 180 days (p = 0.11).
No adverse events; 35 patients needed a top-up injection after 2 weeks. Level of Evidence II (as assigned).

What it means for a patient

A drooping tip from ageing can be lifted and projected with two small filler injections, lasting at least six months here.
One in four patients needed a second session at two weeks to reach the target.
The study is by users of one specific product with no comparison; the Level II rating is the journal's assignment.

Why this paper matters

It gives a large series with measured stability of tip filler over six months. Limits: single product, no control, measurements only to 180 days.

Terms

Cross-linked hyaluronic acid: filler gel chemically bonded (here with BDDE) to last longer.
Tip rotation: the upward tilt of the tip.
Tip projection: how far the tip stands out from the face.
GAIS: Global Aesthetic Improvement Scale.
Nose hypotonia (ageing): loss of tip support with age, causing droop.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Introduction: Projection and upper rotation to the tip is fundamental in the nasal rejuvenation, as a matter of fact the tip is the most important and has strongly effects on the improve appearance and quality of life. The aim of the present study was to evaluate reshaping the tip of the nose by cross-linked hyaluronic acid using Italian technique.

Methods: In a period between November 2019 and 2023, a total of one hundred and forty healthy, 95 females and 45 man patients, were performed with a mean age 44±5 (age range: 31-52 years old) affected by tip of congenital (22) or ageing nose hypotonia (118), and reduced volume that need of an elevation of the nose tip. The anatomic markers have been considered for the anthropometric measurements after the filler rhinoplasty. Two infiltrations were performed, one in the infiltration into the antero-caudal access over the columella produce upward rotation of the tip of the nose and second infiltration into the antero-superior access produce the projection of the tip of the nose. Medical device used in the study was Neofound STRUCT LIDO (LOVE COSMEDICAL srls-Via Toniolo 9, 57022 Castagneto Carducci, ITALY) containing sodium hyaluronate/hyaluronic acid high molecular weight (1.500<HA<2.000 KDA) 24%, sodium hyaluronate/hyaluronic acid low molecular weight (155<HA<230 KDA) 9%, niacinamide, glycine, proline, BDDE, and lidocaine chlorhydrate 3%.

Results: The effect on the upward rotation of the tip nose was evaluated using Global Aesthetic Improvement Scale and morphometric evaluation. All the subjects showed at least 2-3 grade improvement in GAIS score after HA filler injection. The analysis of patient satisfaction after the last follow-up visits clearly demonstrated good results. A significant morphometric difference was detected comparing the T0 and T90 (p<0,0001), while no difference was present comparing T90 and T180 means (p=0.11). The outcome of the present clinical study gives greater projection and upper rotation to the tip with great gratification of the patients and the surgeon. An augmentation of the tip nose with hyaluronic acid filler produces a rejuvenation of the nose area resulted in a more youthful appearance. No adverse event was observed. In 35 patients, additional HA infiltration had to be performed after 2 weeks.

Conclusion: In conclusion, the Italian technique descripted in the present paper is safe, simply, and efficacious for rejuvenation of the nose, with elevated levels of patient satisfaction.

Level Of Evidence Ii: 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).