Q: Dr. Eppley, I feel like the base of my nose is sunken in and needs to be built up. I know that implants are made for the paranasal area but I just don’t want a piece of synthetic material in me. How else can this be done, injectable fillers, bone grafts etc?
A: Paranasal augmentation is the buildup of the portion of the midface around the base of the nose. It should be differentiated from submalar and premaxillary regions of the midface of which they can often be confused. When considering paranasal augmentation, the most common technique is a preformed synthetic paranasal implant. But an implant is not the only paranasal option. Other choices include injectable materials and an autogenous graft. While there are numerous off-the-shelf synthetic injectable fillers, they all have only a temporary effect. For a permanent injectable material, I would use either hydroxyapatite or HTR granules which can be ‘injected’. This is not done in the typical percutaneous approach through a fine needle. Rather it is done through a small intraoral incision and placed on top of the bone underneath the base of the nostrils. The granules or beads are packed into a syringe but are only injected through the open end of its barrel so it requires an incision and some limited subperiosteal pocket dissection to be injected. These materials are non-resorbable and gets good tissue ingrowth. From an onlay graft option, small rib grafts taken from a very small incision at the bottom of the rib cage will also work well and will not resorb unlike onlay bone grafts.
Dr. Barry Eppley
Indianapolis, Indiana