Nonsurgical Rhinoplasty: Results from a Retrospective Study of Rino-4-Puntos Technique with Hyaluronic Acid

Silikovich F, Kroumpouzos G.

PubMed 39060796 Publisher (DOI)Free full text (PMC)

What this paper says

In 400 patients treated with a four-point filler protocol using a mean 0.65 mL of hyaluronic acid, 93% rated the result at least satisfactory, the effect lasted a median of 11 months, and there were no vascular complications.

Overview

Nasal filler lacks standardisation. Silikovich describes the Rino-4-Puntos (R4P) technique, with defined injection points, depths and volumes: radix (0.05-0.15 mL, on the periosteum), supratip (0.025 mL, on the cartilage), tip (0.15 mL, deep fat) and columella (0.30 mL, split into four sub-points). Intermediate-firmness filler is used at points 1-3 and high-firmness at point 4. Consecutive patients from January 2021 to July 2023 were reviewed.

Sections of note

400 patients, 71% female.
Indications: dorsum straightening 21%, tip triangulation 32%, projection 25%, columella strengthening 22%.
Mean total volume 0.65 mL (SD 0.17).
Small boluses (0.05 mL or less) in the midline at deep planes; no vascular complications.
93% rated the outcome good, very good or excellent; median duration 11 months. Level of Evidence IV.

What it means for a patient

A defined, low-volume, midline, deep-plane protocol produced no artery blockages in 400 cases.
Results lasted just under a year on average.
Satisfaction was self-reported and the study is retrospective from the technique's inventor.

Why this paper matters

It is a large series of a fully specified filler protocol, which is what the field lacks. Limits: retrospective, single injector, unvalidated satisfaction scale.

Terms

G prime (G'): a measure of filler firmness; higher G' lifts more.
Supraperiosteal: placed directly on the bone surface.
Suprachondrial: placed directly on the cartilage surface.
Bolus: a single deposit of filler.
Columella: the strip of tissue between the nostrils.

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

Abstract

Background: Nonsurgical rhinoplasty (NSR) utilizing hyaluronic acid (HA) filler injections is increasingly used to address nose shape issues. While refinements have been proposed, the technique lacks standardization.

Objectives: Our study aimed to evaluate the aesthetic outcome, longevity of results, safety, and patient satisfaction with the novel Rino-4-Puntos (R4P) NSR technique.

Methods: This is a retrospective study of consecutive individuals treated with R4P between January 2021 and July 2023. All participants had one of the four indications: rectification of the dorsum (21%), triangulation of the tip (32%), projection (25%), and strengthening of the columella (22%). Each patient received two hyaluronic acid (HA) fillers: one with intermediate G prime (G') at Points 1-3 and another with high G' at Point 4, which is further divided into Points 4.1, 4.2, 4.3, and 4.4. The injection points were as follows: P1 (radix, 0.05-0.15 mL, supraperiosteal), P2 (supratip, 0.025 mL, suprachondrial), P3 (tip, 0.15 mL, deep fat), P4 (columella, 0.30 mL, supraperiosteal [4.1], or deep fat [4.2, 4.3, and 4.4]).

Results: Four hundred individuals (n = 284 [71%] females) are included. The mean filler volume used was 0.65 ± 0.17 mL. Injecting small boluses (≤ 0.05 mL) in the midline at deep planes minimized the risk of adverse effects, as no vascular complications occurred. Ninety-three percent of participants considered the overall outcome at least satisfactory ("good," "very good," or "excellent"). The treatment effect was maintained for a median of 11 months.

Conclusions: The R4P technique refines NSR by combining enhanced aesthetic outcome, longevity, and safety.

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).