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Analysis and Evaluation of Nasal Angles in Non-Surgical
Rhinoplasty with Hyaluronic Acid
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Análisis y evaluación de los ángulos nasales en rinoplastia
no quirúrgica con ácido hialurónico
Arroyo Armijo, P.a Contreras Rojas. I. b Rojo Pereira, J. c Hernández Quezada, R. d
a. DDS. Docente, Virtus Academy, Santiago Chile.
b. DDS., Virtus Academy, Santiago Chile.
c. DDS. Docente, Virtus Academy, Santiago Chile.
d. MSc. Docente, Universidad de Chile, Santiago Chile.
Recibido 2025-01-19
Revisado 2025-03-28
Aceptado 2025-04-07
Abstract
Background:
Studies show the efcacy and safety of nasal reshaping with hyaluronic acid. However, there is little evidence on the clinical
parameters modied to achieve an aesthetic improvement in the nasal prole. In aesthetic analysis, the nasolabial angle has
often been used to evaluate the rotation of the nasal tip in non-surgical rhinoplasty, a parameter dependent on the position
of the upper lip. The researchers declare no conicts of interest.
Objetive:
The purpose of this study is to demonstrate the changes induced by non-surgical rhinomodelling in the nasal prole by
measuring the nasolabial angle traced on soft tissues and the new nasal angle proposed by the authors. Additionally, the
study highlights the efcacy and safety of nasal reshaping with hyaluronic acid.
Methods:
This is a prospective open-label study where the outcome of non-surgical rhinoplasty treatment with cannula (23G x 38 mm)
was evaluated in 25 adult patients (treated in the areas of the nasal spine, columella, and supratip) using a maximum of 0,6
ml of hyaluronic acid.
Results:
Twenty-ve patients participated in this study (22 women and 3 men) with an average age of 34 years. An average of 0.33
± 0.11 ml of hyaluronic acid was inltrated during the procedure. Twenty-two patients underwent this procedure for the rst
time during this study, while the other three had undergone between 1 to 3 previous procedures. Only two patients required a
second intervention, using an average of 0.18 ml. Nasolabial angles before and after treatment were measured; on average,
this increased from 89.3 ± 11.3° to 98.4 ± 8.2° (average change of 9.1 ± 7.3°). No complications were recorde.
Conclusion:
Statistically signicant changes were observed when comparing the nasolabial angle measurements before and after the
procedure, with an average increase of 9º, as determined through nasal prole analysis and subsequently tested in STATA 11
(P=0.0000). Additionally, given that the nasolabial angle may vary due to aging and modications in perioral structures, it is
necessary to measure another angle to assess nasal tip projection.
Keywords:
Hyaluronic acid, nasal remodeling, non-surgical rhinoplasty, facial prole analysis, nasolabial angle.
Arroyo Armijo, P., Contreras Rojas. I., Rojo Pereira, J., Hernández Quezada, R. (2025) Analysis and Evaluation of Nasal Angles in Non-Surgical Rhinoplasty with Hyaluronic Acid. Odontología Vital, 2(43)
31-41. https://doi.org/10.59334/ROV.v2i43.666
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Introduction
Minimally invasive procedures such as
neuromodulator injections, hyaluronic and
non-hyaluronic acid llers, among others, have
gained popularity in recent years. Currently,
Generation X (born between 1965 and 1981)
represents 46% of all these procedures, while
Baby Boomers (born between 1946 and 1964)
represent 31%. Together, these two age groups
account for 77% of the total market for minimally
invasive procedures (Kumar et al., 2021).
The nose harmonizes and balances the face;
it is its centerpiece, indicative of our heritage,
and it is closest to the lens when taking a
photo, and probably the most distorted when
looking in the mirror. A well-structured nose
enhances the beauty of the entire face. For
this reason, rhinoplasty has emerged as a
treatment alternative, and in recent years,
with the increased popularity of hyaluronic
acid injectable llers, non-surgical rhinoplasty
has become a less invasive option (American
Society of Plastic Surgeon, 2021, 2022).
Surgical rhinoplasty is a procedure under
general anesthesia that involves a recovery
process of about one year. Often, patients do
not wish to undergo this procedure due to
potential functional decits, dissatisfaction with
the nal results, and failed results due to surgical
complications leading to revision rhinoplasties. In
contrast, non-surgical rhinoplasty is less invasive,
requires minimal downtime, and the results are
temporary and reversible, making it a treatment
of choice for some patients (American Society of
Plastic Surgeon, 2021, 2022).
Generally, non-surgical rhinoplasty with
hyaluronic acid is a safe and satisfactory
procedure for patients. Despite its increased
popularity, complications remain low and mostly
minor. Nonetheless, it is essential to be aware of
severe complications for prevention and proper
management (DeVictor et al., 2021).
To reduce the risk of vascular complications,
it is recommended to aspirate when using a
needle to ensure not being in a vascular territory,
inject slowly, and in small volumes. Additionally,
the use of a cannula instead of a needle is
suggested. Regarding the technique, the ller
should be placed along the midline and under
the subcutaneous and musculoaponeurotic
system layer where the main nasal vasculature
is located (Bertossi et al., 2019; DeVictor et al.,
2021).
Furthermore, it is crucial for the injector to have
a comprehensive understanding of ideal facial
proportions, anatomy and age-appropriate
aging characteristics to achieve predictable
and successful results. Facial symmetry
and harmony are often dened as the most
important characteristics of facial beauty and
ideal proportions (Akinbiyi et al., 2020).
The objective of this study is to measure and
demonstrate the changes induced by non-
surgical rhinoplasty in the nasal prole by
assessing the nasolabial angle traced on soft
tissues and the new nasal angle proposed by
the authors. Additionally, the study highlights
the efcacy and safety of nasal reshaping with
hyaluronic acid.
Materials and Methods
Study Design and Patient Selection:
This was a prospective, open-label study
where the outcome of non-surgical rhinoplasty
treatment with a cannula (23G x 38 mm) was
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evaluated. Procedures were carried out between
September 2023 and January 2024, and all
patients signed informed consent.
Twenty-ve patients aged 21 to 58 who wanted
to improve the appearance of their nose
without undergoing surgery were selected.
Selection criteria included patients with realistic
expectations, without signicant deformities,
and without functional impairments. Additionally,
for patients who had undergone previous
treatment, at least six months have been waiting
since the last intervention.
Other exclusion criteria included pregnant or
breastfeeding women, patients with previous
surgical rhinoplasties, patients with autoimmune
diseases, and individuals under 18 years old.
These patients were followed telematically for
30 days to evaluate possible complications and
satisfaction with the procedure.
Procedure:
All procedures were performed with high cross-
linking hyaluronic acid (23 mg/ml HA) using
a cannula injection technique, inltrating an
average total volume of 0.33 ml in the nasal
spine, columella, and infratip nasal areas. The
treatment’s objective was to harmonize the nose
by opening the nasolabial angle and projecting
the tip, incorporating slight rotation in certain
cases.
Prior to the injection, intraoral anesthesia is
administered using 3% lidocaine (without a
vasoconstrictor). The access point at the base
of the nose is then disinfected with 70% alcohol,
after which the cannula is inserted into this area.
Regarding the technique, the cannula is
introduced at the base of the nose, centered
along the midline, directed towards the nasal
spine, where a microbolus of 0.05 to 0.1 ml is
inltrated. The cannula is then pre-curved at
45°, with the opening facing the posterior of
the columella, to perform three linear retro-
injections of 0.05 ml each, descending from the
infratip to the base of the nose. Finally, a last
microbolus (before the nal retro-injection) is
deposited in the infratip to project the nasal tip
with 0.05 to 0.1 ml (Figure 1).
Figure 1. Schematic representation of the
injection technique used.
Figure 1. Schematic representation of the injection technique used.
First, a microbolus of 0.05
to 0.1 ml is injected. Then,
three linear retroinjections
of 0.05 ml are performed,
descending from the
infratip to the nasal base at
an average injection speed
of 7 seconds. Finally, a last
microbolus (before the nal
retroinjection) is deposited
in the infratip to project the
nasal tip, ranging from 0.05
to 0.1 ml.
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Upon completion of the procedure, all patients
were provided with post-operative instructions
both verbally and in writing. Touch-ups were
scheduled for one month after the initial
intervention, if necessary.
Standardized pre- and immediate post-
treatment photographs were taken of all
patients participating in this study using the
PhotoDoc application. The photographs were
taken from a distance of 1 meter and using an
18’’ 15V ring light.
Five standard clinical photographs (i.e., frontal
view, both 45° oblique views, and both lateral
views) were taken for each patient in identical
positions. However, for the anthropometric
evaluation, only the right lateral views were used.
Statistical Analysis:
The impact of the treatment was evaluated
by measuring the nasolabial angles in patient
photographs before and after the procedure
using Digimizer software.
The data obtained were analyzed with STATA 11
statistical software, assessing their distribution
with the Shapiro-Wilk test and comparing the
groups using the appropriate statistical test for
paired samples.
The nasolabial angle was measured considering
the angle formed between the inferior edge of
the columella and the line drawn between the
subnasal point and the superior border of the
upper lip (Figure 2).
The nasolabial angle is the angle between the
lower edge of the columella and the line that
passes through the subnasal point and the
upper edge of the upper lip.
Figure 2. Measurement of the nasolabial angle in a standardized prole photograph.
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Additionally, a proposed nasal angle was
measured, corresponding to the angle between
the true vertical line (perpendicular to the
Frankfurt Plane passing through the subnasal
point) and the inferior edge of the columella
(Figure 3).
Figure 3. Facial prole analysis for non-surgical rhinoplasty.
For an adequate prole analysis of a
patient requiring non-surgical rhinoplasty,
we suggest the measurement of various
facial parameters: the nasal angle
proposed in this article; which corresponds
to the angle formed between the true
vertical and the lower edge of the
columella, the fronto-nasal angle and the
height of the radix.
With all these measurements, descriptive
statistics are provided, including mean, standard
deviation, and range for continuous variables,
while frequency were provided for categorical
variables.
Results
Patient Characteristics and Treatments:
Twenty-ve patients participated in this study, 22
women and 3 men, with an average age of 34
years ± 9 years. Three of the total patients had
previously undergone non-surgical rhinoplasty.
An average volume of 0.33 ml ± 0.11 ml (range
0.2-0.6 ml) was injected into the patients during
the rst intervention. Only two patients required
a subsequent second intervention, receiving 0.1
ml and 0.25 ml, respectively. On average, 0.05
ml was injected into the infratip area, 0.18 ml into
the columella, and 0.9 ml into the base of the
nose (Table 1).
Table 1. Injected Volumes of Hyaluronic Acid.
Total volume (ml) Infratip volume (ml) Columella volume (ml) Nasal spine volume (ml)
0,4 0 0,2 0,2
0,45 0,05 0,2 0,2
0,4 0 0,2 0,2
0,5 0,1 0,2 0,2
0,3 0,1 0,1 0,1
0,35 0,05 0,3 0
0,6 0,1 0,3 0,2
0,5 0,05 0,25 0,2
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0,25 0,05 0,15 0,05
0,25 0,05 0,15 0,05
0,25 0,05 0,15 0,05
0,3 0,05 0,15 0,05
0,25 0,05 0,15 0,05
0,25 0,05 0,15 0,05
0,25 0,05 0,15 0,05
0,25 0,05 0,15 0,05
0,4 0,1 0,2 0,1
0,35 0,1 0,2 0,05
0,25 0,05 0,15 0,05
0,25 0,05 0,15 0,05
0,25 0,05 0,15 0,05
0,2 0,05 0,15 0
0,3 0 0,2 0,1
0,3 0 0,15 0,15
0,25 0 0,15 0,1
0,33 0,05 0,18 0,09
The total volumes of hyaluronic acid and the volume inltrated in each area of the nose are provided. The average
values are shown in the last row.
Efcacy of the Treatment:
The mean nasolabial angle increased from
89.3 ± 11.3° before treatment to 98.4 ± 8.2° after
treatment, with a mean change of 9.1 ± 7.3°
(range 3°-34°) (Table 2).
Table 2. Nasolabial Angle Measured Before and After Treatment.
Pre-treatment nasolabial angle Post-treatment nasolabial angle Nasalolabial angle increase
84 91 7
58 92 34
85 96 11
92 100 8
108 111 3
104 108 4
91 105 14
104 105 1
90 97 7
94 103 9
82 89 7
105 109 4
78 82 4
78 82 4
89 90 1
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81 96 15
92 106 14
94,8 98 3,2
98,6 105 6,4
88,6 91,8 3,2
105,7 109,9 4,2
95 102,4 7,4
80,2 92,6 12,4
79,6 105,1 25,5
86,2 93,2 7
89,7 98,4 8,7
Additionally, the difference between both measurements is provided to determine the increase in the nasolabial angle.
The average values are shown in the last row.
When measuring the proposed nasal angle in
this article, it increased from 106.3 ± 6.7° to 114.9
± 5.5°, with a mean change of 8.7 ± 4.4° (range
2.5°-19.3°) (Table 3).
Table 3. Nasal Angle Measured Before and After Treatment.
Pre-treatment nasal angle Post-treatment nasal angle Nasal angle increase
111,9 116,6 4,7
96,1 115,4 19,3
102,3 110,9 8,6
109,9 120,4 10,5
106,3 122,2 15,9
106,5 112 5,5
106,4 116,2 9,8
104,7 118 13,3
111,7 120 8,3
106,4 112,5 6,1
104,7 110,4 5,7
111,6 117,7 6,1
102,9 107,9 5
111,5 116,6 5,1
109,2 121 11,8
100 104,9 4,9
101,7 107,9 6,2
105 111,3 6,3
105 118,2 13,2
112 118,3 6,3
115,2 121,6 6,4
116,7 123,7 7
100,1 110,3 10,2
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85,5 103,7 18,2
113 115,5 2,5
106,3 114,9 8,7
Additionally, the difference between both measurements is provided to determine the increase in the nasal angle. The
average values are shown in the last row.
These improvements demonstrate a signicant
increase in the nasolabial angle and an
increase in nasal rotation, resulting in a cosmetic
enhancement of the prole.
The results of the statistical analysis suggest a
signicant improvement in the angle following
the treatment compared to the initial value. The
Shapiro-Wilk test indicates that the data follow
a normal distribution both before and after the
treatment (p > 0.05 in both cases), validating the
use of a parametric test.
The paired t-test shows a signicant mean
difference of -9.088 degrees between the
pre- and post-intervention angles, with a 95%
condence interval ranging from -12.15 to -6.02
(p < 0.0001). The t-value (-6.1186) supports that
the observed difference is not due to chance,
suggesting that the treatment was highly
effective in improving the evaluated angle
(Figure 4).
Figure 4. Statistical Analysis.
Statistical analysis showing the Shapiro-Wilk test and the paired t-test.
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Complications:
No complications were recorded in the patients.
Discussion
Among the facial measurements for treatment
planning in the nose, the nasolabial angle
allows us to evaluate the effectiveness of nasal
tip rotation, as it is one of the parameters that
dene the shape of the nose (Alshawaf et al.,
2024; Youn & Seo, 2016).
In this regard, it is benecial to have analysis
methods like Digimizer to evaluate the changes
over time. However, there are few studies on
the use of software for soft tissue analysis and
treatment planning.
Better methods for measuring the nasolabial
angle need to be established as there is no
consensus among professionals. While this
article considered the angle between the
tangent line to the columella and the line
drawn from the subnasal point to the upper lip’s
edge, other studies have considered the angle
between the tangent line to the columella and
the line drawn from the subnasal point tangent
to the philtrum (Alshawaf et al., 2024).
Additionally, it is crucial to question the utility of
the nasolabial angle in evaluating treatment
outcomes, as it is inuenced by age-related
changes. These changes include an increase
in nasal dimensions, nasal tip ptosis, and the
progressive resorption of the maxillary bone,
which further reduces nasal tip projection and
consequently sharpens the nasolabial angle
(Helal et al., 2019; Shastri et al., 2021).
Similarly, facial harmonization procedures in
the lip area and orthodontic treatments can
also modify the nasolabial angle by altering the
position of the upper lip (Pop et al., 2025).
In this article, we propose the measurement
of a nasal angle that is independent of the lip
position. This angle corresponds to the tracing
between the tangent line to the columella and
the line perpendicular to the Frankfurt plane that
passes through the subnasal point. This way,
the measurements would be more reliable by
reducing the standard variation.
For a more detailed evaluation, it is
recommended to analyze other facial
parameters, such as the frontonasal angle
and the percentage increase in radix height,
as described in Figure 2 (Youn & Seo, 2016). A
comprehensive evaluation is necessary, tracing
vertical and horizontal lines to assess the nose
in relation to the rest of the facial structures
(Alshawaf et al., 2024).
Non-surgical rhinoplasty is a procedure whose
effects last up to 8 to 12 months. To maintain
these results over time, it is necessary to repeat
the procedure at least once a year, which can
cause more brosis in the long term (Bertossi
et al., 2022; Frédéric et al., 2023). In this regard,
it is essential to consider the repercussions of
repeating the procedure over the years and to
consider the alternative treatment of surgical
rhinoplasty.
Conclusions
In this study, non-surgical rhinoplasty treatment
with up to 0.6 ml of hyaluronic acid was well
tolerated, safe, and effective. The recovery time
was minimal (14 days). Objective evaluations
using Digimizer demonstrated signicant
changes in nasolabial angles before and after
treatment.
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Given that the nasolabial angle can vary due to
aging and modications in perioral structures,
it is necessary to measure another angle
to evaluate nasal tip projection. This article
proposes a nasal angle dependent on the
columella, the Frankfurt plane, and a vertical line
perpendicular to it.
A thorough understanding of nasal anatomy
and the technical specications for injecting this
area remains essential to avoid complications.
Declarations
This study adhered to bioethical principles of
autonomy, benecence, non-malecence,
and justice, ensuring the safety and rights of
participants.
A detailed informed consent was obtained
prior to inclusion, outlining the study objectives,
procedures, risks, benets, and data
condentiality.
Only adult patients without contraindications
for hyaluronic acid were included, while those
with allergies, autoimmune diseases, pregnancy,
or who were minors were excluded. Personal
data were protected in accordance with
current regulations, and no adverse effects or
complications occurred during the study.
AUTHOR CONTRIBUTION:
The authors have contributed to the conception,
planning, execution and approval of the nal
version of this article.
Conict of interest:
The authors declare that they have no conicts
of interest.
Funding:
Declaración de contribución de autores:
Conceptualización y diseño: PA
Revisión de literatura: JR PA IC
Metodología y validación: JR RH PA
Análisis formal: PA IC
Investigación y recopilación de datos: PA IC
Recursos: PA
Análisis e interpretación de datos: PA IC RH
Redacción-preparación del borrador original: IC
PA
Redacción-revisión y edición: IC
Supervisión: PA
Administración de proyecto: PA IC
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Derechos de autor ©2025 Arroyo Armijo, P., Contreras Rojas. I., Rojo Pereira, J., Hernández Quezada, R.
