Rhinoplasty was the top-ranked surgical procedure of 2020, according to the American Society of Plastic Surgeons—proving the nose to be a common source of insecurity during the pandemic. If you’re even mildly obsessed with yours, you probably already know that surgery isn’t the only way to address a bothersome dorsal hump or droopy tip. Described in this 2020 study as “one of the fastest-growing cosmetic procedures worldwide,” filler rhinoplasty continues to impress, with its temporary yet transformative powers and booming body of research. Within the past two years alone, dozens of studies on liquid rhinoplasty have peppered the plastic surgery literature, exploring the procedure’s popularity, risks, and satisfaction rates—all of which, for the record, are significant.
Meanwhile, another form of nonsurgical rhinoplasty has been building buzz among a select group of providers: the nose thread lift. “As the popularity of thread lifts is increasing, so too is the diversity of how they’re being used,” says Dr. Y. Claire Chang, a board-certified dermatologist in New York City. “I have a growing number of patients requesting thread lifts for nose contouring”—a technique she picked up from a plastic surgeon colleague in Seoul, South Korea, just prior to the pandemic.
Of course, when you marry two hotly debated procedures—nonsurgical rhino and thread lifts—controversy is inevitable. Some physicians question the efficacy and durability of threads in the nose; others simply believe the potential risks of the treatment outweigh the rewards. Ahead, fans and critics of the nose thread lift weigh in on the trending procedure.
What is a nose thread lift?
“Nose thread lifting is a quick and simple nonsurgical procedure with minimal downtime,” says Dr. Chang. Modern threads are made from absorbable polymers like polydioxanone (PDO)—the same materials comprising surgical sutures. “PDO dissolves over the course of four to eight months, depending on its thickness and attachments, and most people do not have allergic reactions to PDO suture material,” says Dr. Shasa Hu, a board-certified dermatologist in Miami. Unlike with rhinoplasty surgery, there is no general anesthesia involved. Once the nose is anesthetized with a topical anesthetic, the threads are inserted using a cannula. “I initially inject lidocaine, to numb the insertion point of the threads, which may be at the nose tip or within the nasal cavity,” Dr. Chang notes.
The number of threads and the areas of the nose where they are placed will depend on the patient’s anatomy and goals, but in most cases, multiple threads are injected, sometimes over the course of several sessions. “For nose lifts or correction of a droopy tip, I typically use three threads, inserting from the tip of the nose toward the bridge in a V fashion, to provide vertical and lateral support,” Dr. Hu explains.
What issues can a nose thread lift address?
First off, it’s important to understand that threads cannot alter the structure or shape of the nose in order to truly fix whatever it is that may be bugging you. They merely shift and shape the tissues, to make certain aspects of the nose appear slimmer or higher or more upturned for a short time. “You’re limited in terms of what you can do with a thread,” says Dr. Hema Sundaram, a board-certified dermatologist in Fairfax, Virginia, and Rockville, Maryland. “You’re hoisting up a relatively weighty area of the face with little, absorbable sutures—you can’t expect to have very significant or long-lasting results.”
But proponents of the nose thread lift tell us that the procedure can be quite satisfying, if patients have realistic expectations and their concerns and desired result match the threads’ capabilities. “Depending on the technique and type of thread used, thread lifts can elevate the nasal bridge, straighten and heighten the nose contour, and/or lift the tip of the nose,” Dr. Chang says. The effects on the appearance of your nose are subtle—“millimeters of difference, at most,” says Dr. Hu—however, she adds, “even a millimeter change in bridge elevation or a few degrees of lift in a nose tip can improve facial balance.” (Botox can elevate a tip to a similar extent, quickly and with minimal risk of complication, notes Dr. Sundaram.)
What threads cannot do is obscure an obvious hump—which puts them at a definite disadvantage, according to board-certified Beverly Hills, California, facial plastic surgeon Dr. Sarmela Sunder, since one of the main reasons people seek out a nonsurgical rhinoplasty is to conceal the bump that has them feeling self-conscious about their profile. Still, the fact remains, “threads can’t address the bump, like surgery [can], or camouflage it, the way dermal fillers can,” she adds.
Interestingly, while “nose contouring procedures are among the most common cosmetic treatments in Korea,” says Dr. Chang—typically done to give a classic Asian nose “a higher, more pronounced bridge and a more defined dorsum, with an upturned tip”— threads really aren’t powered to build up the bridge of the nose in a major way. For this reason, it’s not unusual for providers to combine threads with injectable fillers when aiming for a greater change.
Who’s a good candidate for a nose thread lift—and who’s not?
Beyond having reasonable expectations and manageable concerns, appropriate candidates for nose threads are generally on the younger side, with decent skin quality. If someone has thin, sun-damaged skin, “thread lifts are not suitable, as the threads may be visible or palpable if there’s not enough dermis to support the thickness of the threads,” explains Dr. Hu.
Another reason older patients may want to think twice before attempting to lift a nasal tip with threads is that their noses are likely drooping due to age-related volume loss and bone resorption in the area. “And if we don’t address the underlying volume loss [with filler], they’re not going to get a lasting or particularly natural-looking result,” says Dr. Sundaram.
While some doctors refuse to inject filler into noses in patients who have undergone a surgical rhinoplasty procedure, Dr. Sunder tells us that nose threads are generally safe for those who’ve had traditional rhinoplasty (as long as nasal implants weren’t used). However, she notes, “placing threads in a previously operated nose can be quite challenging, since there may be significant scar tissue and cartilage grafts through which the thread needs to maneuver.”
Other factors that may disqualify you from having a nose thread lift, according to our experts, are a history of radiation to the nose, a known allergy to the suture material, an active infection or inflammation in the treatment area, and pregnancy or breastfeeding.
Are nose threads safer than nose filler?
Here’s where things get a little divisive. Nose filler is a notoriously dicey procedure, since the blood vessels in the area share connections with the retinal artery feeding the eye—meaning that a misplaced poke could cause immediate and permanent blindness. This is a very rare but real risk with a liquid nose job. “In a review of worldwide literature from 2015–2019, nose filler was associated with the highest number of cases of vision loss from retrograde embolization [or backflow] of the filler material into the blood vessel supplying the retina,” says Dr. Hu. When injecting the nose, there’s also a risk of necrosis, or skin death, if filler clogs an artery responsible for nourishing the skin of the nose or an adjacent area.
In the pro column for filler, Dr. Hu adds, “we have a lot more control and precision with nose filler compared to threads, when it’s done with careful patient selection and safe technique.”
While some providers insist that nose thread lifts are safer than filler nose jobs—finding it unlikely that a suture would block an artery, causing a vascular occlusion—others say this contention is unfounded and, therefore, debatable. “Nose thread lifts are being touted by some as a safer alternative to nose fillers, without the evidence or experience to support this,” Dr. Sundaram says. In her opinion, threads may pose a similar risk of vascular compromise—only by a somewhat different means. If a provider hits a vessel while inserting the threads, causing the tight envelope of the nose to fill with blood, “vascular compression, ischemia [reduced blood flow], and tissue death could result,” she explains. Likewise, Dr. Sundaram adds, if there’s “swelling due to traumatic insertion of threads, swelling of the threads themselves after implantation, or swelling from scar tissue that forms after insertion,” vital arteries could get compressed and their blood supply restricted or cut off. She also worries about the potential nerve damage that could occur if a nerve is hit by a thread or squeezed by inflamed tissue or pooling blood. In short, “we don’t have sufficient evidence, at this stage, to truly know the safety profile for nose threads,” Dr. Sundaram says.
What are the known risks of the nose thread lift?
Possible side effects and complications range from ordinary bruising, pain, and swelling to infection, nodule formation, skin dimpling, buckling of the threads, and extrusion (sutures poking through the skin). “Because PDO is a foreign material, there is also a risk of inflammation and allergic reaction,” notes Dr. Chang.
Perhaps the biggest strike against the procedure is its irreversibility. Unlike with hyaluronic acid filler, if there is a problem with the threads or you’re unhappy with the outcome, “there is no antidote,” says Dr. Sunder. You essentially need to wait several months for the threads to dissolve—or find a physician who’s versed in handling thread-related hiccups. “I’ve consulted on complications in patients who had threads to the nose—threads extruding from the skin, infection, damage to the cartilage,” says Dr. Sundaram. “We typically try to get the thread out, but that can be tough, especially if there’s scar tissue or pockets of infection around the thread.” Since threads are often barbed, to better grip the tissue, they rarely slip out without incident.
When treating bad outcomes, she first gets an ultrasound in order to see what’s going on beneath the skin, and will then prescribe antibiotics, to tackle infection, if present, and prevent it from spreading. Since the nose is a danger zone, “you can get some pretty catastrophic complications, if you start doing aggressive maneuvers in that region,” she adds. “Attempting to remove misplaced, extruded, or infected threads could traumatize the skin and underlying tissues and lead to scarring, ischemia, and/or necrosis.”
The scar tissue that threads leave in their wake can also pose problems, if you someday decide to surgically change the shape of your nose, points out Dr. Sunder. Not only can the scar tissue make the dissection during rhinoplasty surgery more complicated, she says, but “it can potentially impact your healing following a rhinoplasty.”
The bottom line on nose thread lifts
For those seeking “mild improvement in height, projection, or definition of the nose contour,” says Dr. Chang—as in, a slightly higher or slimmer bridge or tip—the nose thread lift may be a solid nonsurgical option. The procedure, while minimally invasive, is not without risk, and the results are neither dramatic nor lasting. (Moreover, it can’t hide or reduce a prominent hump.) If you’re set on trying this tweak (which can run between $700 and $1,200), find a board-certified dermatologist or plastic surgeon who has considerable experience placing threads in the nose.
