Nonsurgical Rhinoplasty: A Modified Rino-4-Puntos Technique With Hyaluronic Acid Improves the Appearance of Nasal Septal Deviation

Silikovich F, Kroumpouzos G.

PubMed 40416407 Publisher (DOI)Free full text (PMC)

What this paper says

In 80 patients with a mildly to moderately crooked front septum, a modified four-point filler technique that angles the columellar injections against the deviation left 87.5% very satisfied, 81.2% reporting easier breathing, effects lasting a median 11 months, and no vascular complications.

Overview

No filler technique had been tested specifically for the appearance of a deviated septum. Silikovich modified his Rino-4-Puntos method at points 4.2 and 4.3 (columella): the needle enters on the side of the deviation and is directed diagonally away from it toward the tip. Consecutive patients were reviewed retrospectively.

Sections of note

80 patients, 68.7% women.
Suitable for mild-to-moderate caudal deviation, including I- and C-shaped.
87.5% very satisfied, 12.5% satisfied with appearance.
81.2% reported respiratory improvement.
Median duration 11 months; no vascular complications.

What it means for a patient

Filler can make a mildly crooked nose look straighter for about a year; it does not straighten the septum itself.
The reported breathing improvement is self-reported and unexplained mechanically; filler does not enlarge the airway.
Severe deviations are not candidates.

Why this paper matters

It extends a standardised filler protocol to a specific indication with a reasonable series. Limits: retrospective, single injector, subjective outcomes, no objective airflow measurement.

Terms

Nasal septal deviation (NSD): a bent septum causing a crooked appearance or blocked breathing.
Caudal deviation: a bend at the front edge of the septum, visible at the columella.
G prime (G'): filler firmness.
Columella: the strip between the nostrils.

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

Abstract

Background: Recently, we introduced the Rino-4-Puntos (R4P) nonsurgical rhinoplasty technique using hyaluronic acid (HA), which effectively addresses nose shape issues. However, no nonsurgical rhinoplasty procedure has been explicitly tested for improving the appearance of nasal septal deviation (NSD). This study aimed to evaluate the aesthetic outcome, longevity of results, safety, and patient satisfaction of the modified R4P (mR4P) technique, designed to address nose shape issues related to NSD.

Methods: This was a retrospective study of consecutive patients treated with mR4P. NSD is the leading cause of unpleasing aesthetics. The R4P technique involves targeted injections with an intermediate G prime (G') HA at the radix (point 1), supratip (point 2), and tip (point 3), and high G' HA at the columella (point 4). To specifically address nose shape issues caused by NSD, modifications were made to points 4.2 and 4.3 of the technique. At these points, the needle insertion point was repositioned to the side of deviation. Then, the needle was directed diagonally opposite the deviation toward the nasal tip.

Results: Eighty individuals (68.7% women) were included. The procedure is suitable for mild-to-moderate caudal NSD, including I- and C-shaped NSDs. Notably, 87.5% of the participants were very satisfied and 12.5% were satisfied with the aesthetic outcome. Most (81.2%) patients reported respiratory improvements after mR4P. The treatment effect lasted for a median of 11 months. No vascular complications occurred.

Conclusions: The mR4P technique improves the appearance of caudal NSD and provides good longevity of the aesthetic outcomes and safety.

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