Nose thread lift - Ultra V Hiko Nose Threads

Traditionally, nose augmentation or improving the nose profile has been limited to rhinoplasty (commonly referred to as "surgical nose job") and nose fillers

The recent trend for nose augmentation is starting to see a shift away from fillers and instead moving towards nose threadlifts due to the improved safety profile. Nose threadlifts are also known as Hiko nose threadlifts.  This procedure was first introduced in Korea 15 years ago. 'Hi' means high and 'Ko" means nose in the Korean language.

Here's a comprehensive FAQ that I've written for nose threadlifts. Enjoy!

What is the Ultra V Hiko nose threadlift / thread lift?

Hiko nose threadlift is also commonly referred to the "lunch time nose job" because my patients have been able to leave my clinic within 30 minutes and resume their daily activities. The nose threadlift are performed by placing very fine threads in the supraperichondrial and supraperiosteal plane of the nose without requiring any incision or surgery, thereby lifting the nose bridge and tip immediately!

Essentially, the hiko nose threadlift is a cross between nose dermal fillers and surgical rhinoplasty. It combines the benefits of dermal fillers (e.g. no incision, no downtime...etc.) and surgical rhinoplasty (e.g. longer lasting results).

What are the improvements seen with a nose threadlift?

1. Higher nose bridge
2. Sharper and better defined nose bridge
3. Straighter nose bridge
4. Sharper nose tip
5. Correction of bulbous nose
6. Shrinkage of nostrils

 

How is the Hiko nose threadlift performed?

Let's go through a detailed step by step analysis on how a nose thread lift is done
We can go through a patient who has kindly agreed for the use of her pictures

  

Step 1
After removing makeup and dirt from the face, the face is sterilised with Iodine and Chlorhexine. Next, localanaesthesia is placed at the tip of the nose, nose bridge and along the nasal septum to the philtrum. These are the locations for which the threads will be inserted, both to build up the nose bridge height as well as the nose tip.

Step 2

Once the nose is numb, the threads are introduced using a blunt cannula which is then removed. Nose threads are placed horizontally through the nose tip in the supraperichondrial and supraperiosteal plane. This improves the height and definition of the nose bridge.

Step 3

It is the same process for the nose tip. The threads are then placed vertically through the nasal tip along the columella.

 

What are these threads made of?
The threads are made up of a material called Polydioxanone (PDO). PDO is commonly used in surgeries as sutures to stitch up wounds. PDO is absorbable and is dissolved in 6 to 12 months time.

Fortunately, before the PDO threads are completely absorbed, the threads stimulate your nose to produce its own collagen and connective tissue along where the PDO threads were placed. This collagen and connective tissue produced by your body accounts for the long lasting results of nose threads. Also, the results of the nose threads continue to improve over time even as the PDO threads dissolve away. Patients can expect to see a continued gradual improvement of their nose bridge and nose tip over time.


How long can the threads last?
The results of these nose threads last 1-2 years but with the new collagen and connective tissue produced by your own body, there will some permanent results. However, in patients such as smokers, the results can be shorter lasting.

The Hiko nose threadlifts can be repeated if necessary. This can be done either at the 1 month follow up, or even after 6 months after the initial thread lift.

Is there any pain from the procedure?
Pain level from nose threads are actually surprisingly similar or even less than fillers. Some anaesthesia is used to numb the entry point for the threads. After that, the threads can be inserted with ease into the nose, with minimal pain and hardly any discomfort.

Is there any downtime? Do I need to avoid anything?
There is hardly any downtime. There is very mild swelling and bruising that usually results from the local anaesthesia and this disappears in a few hours. Patients are able to return to work and wear makeup after the Hiko nose threadlift.

You can resume your daily activities and sports too after the Hiko nose threadlift. The nose threads are very stable and secure and will not migrate or change in shape.

In terms of diet, there is no food that you need to avoid too.

I have done fillers before, am I still suitable?
Yes, these threads were particularly designed for those who have gone through fillers previously and are intending to find a more permanent solution but yet are not ready to undergo a rhinoplasty.

For patients unsatisfied with the problems and risks of fillers, the Hiko nose threadlift is a good option.

Rhinoplasty vs Threads
Threads are a great alternative to rhinoplasty for many reasons. First with surgery there is a risk of the implant shifting. Secondly, revision surgery may be necessary if you happen to be unhappy with the result from the surgery. The nose may be not straight, too round, not tall enough etc etc. Third, threads do not leave scars unlike a rhinoplasty that does leave a well hidden scar beneath the columella.

What are the risk of threads then?
As with all procedures, some minor bruising and swelling is expected.  Swelling is usually due to the local anaesthesia and disappears within a few hours as the local anaesthesia wears off.  Ice packs for cold compression can be used to hasten the recovery. Full recovery can be expected in 2-3 days.

There is a small risk of infection (e.g. cellulitis and abscesses) but unlike an implant where a repeat surgery is required to remove the foreign body, threads are easier to remove and the risk of infection is low. In my clinic, the Hiko nose threadlift is performed using sterile techniques and patients are started on antibiotics and this helps to minimize any skin infection. Keeping your face clean at home also helps to reduce the chances o infection.

The nose thread lift has no chance of displacement or shifting. This is because the thread lift thread is placed within the soft tissue. The threads then dissolve within 6 months and natural collagen stimulated. This new collagen is formed by your own body and this gives the long term lasting results for the height increase.

Are threads safer than fillers?
Threads are much safer than fillers for many reasons. Nose fillers have long been plagued with complications like blindness and skin necrosis, due to the inadvertent puncture of fine vessels around the nose and injection of the filler into these vessels, hence limiting blood flow to the eye or the skin resulting in these complications. Although the risk of this happening is extremely low, the risk is still there and the consequences are devastating.

Threads however have no risk of occluding these vessels. The puncture or damage to these vessels do not cause problems, but it is when a filler or gel is injected into these vessels and it tracks into the more narrow vessels that causes these unfortunate events. Although the risk is low, but there has already been 2 blindness cases reported in Singapore till date!!

Secondly, dermal fillers in the nose are known to migrate and can cause broadening of the nose bridge. This unsightly problem does not occur with nose threadlifts as the threads are very stable and can hardly migrate.

Bilateral blindness after filler injection. Published by Dr Kim from Korea.
Plast Reconstr Surg. 2013 Feb;131(2):298e-299e.
https://www.ncbi.nlm.nih.gov/pubmed/23358039

Avoiding and Treating Blindness From Fillers: A Review of the World Literature. Published by Dr Beleznay K
Dermatol Surg. 2015 Oct;41(10):1097-117.
https://www.ncbi.nlm.nih.gov/pubmed/26356847

No doubt I have performed countless number of nose fillers over the years with excellent results, but safety is still of paramount importance to my patients. Hence I would much prefer decreasing the use of these fillers for nose augmentation.

Which type of nose threads do you use?
Ultra V Hiko Nose threads improve the height of the nose and give the sharpest profile.

Some doctors claim using those with cog threads are able to grip better to lift the sagging skin. However from my experience, the results do not differ much from normal Ultra V Hiko threads. In fact these threads may even cause unnecessary tension on the skin and result in scarring or uneven texture on the surface.

How many threads do you use?
It all depends on the height and the baseline we are starting from. It is usual for one to need about 6-8 threads for the bridge and about 4 for the columella. 2-3 threads can be used for the nasion as well.