Posts Tagged ‘paranasal implants’
Thursday, November 24th, 2011
Q: Dr. Eppley, I am interested in creating a more symmetrical look to my face via fillers and eventually implants. As a result of my jaw being asymmetrical, the right side of my lower face appears fuller and more defined than the left. Additionally, my upper jaw is recessed. I have consulted with oral surgeons but none believe my problems are severe enough to warrant jaw surgery as my jaw is fully functional. What do you recommend?
A: The use of injectable fillers does have a role in facial reshaping/contouring but it is more limited than most patients appreciate. Because of the volumes of fillers needed to create visible facial contour changes and their temporary effects, the use of fillers must be done judiciously. For lower jaw asymmetry, and particularly for midfacial flattening, injectable fillers have very little role to play in a long term improvement strategy. Lower jaw asymmetry is often the result of a smaller jawline or mandible on one side. That is best addressed with the consideration of a jaw angle implant. Midfacial flattening, particularly done at the upper jaw level (maxilla, LeFort 1 region), needs horizontal volume augmentation. This is best done with either paranasal, premaxillary or both types of lower level midfacial implants. These would be far more effective than any type of synthetic filler injections.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, jaw angle implants, paranasal implants
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Monday, January 31st, 2011
Q: I have read that paranasal implants can be done in local anesthesia. Is this right? Is local anesthesia possible also with malar implants which are placed right next to paranasal implants? Does not the lifting of the periosteum from the bone hurt in spite of the local anesthesia? Thank you very much for your information.
A: Cheek and paranasal implants are placed from an incision inside the upper lip. Besides the mucosal incision, muscles and the periosteum covering the maxillary and zygomatic bone must be lifted up and a pocket made to place the implants. Given the proximity of the paranasal area to the upper lip compared to the cheek area, it would be ‘easier’ to position paranasal implants under local anesthesia as opposed to cheek implants where greater dissection is needed and the feeling in this area has more contributing nerve endings. You are correct in that it is the periosteum that is the most sensitive part of the surgical dissection. I also prefer to us screw fixation for the implants that I place in the midface which can cause more discomfort from the bone drilling.
While just about any surgery can be done under local anesthesia, I am not sure if I was a patient that I would ever do it that way. (particularly cheek implants) Unless there is some compelling medical reason why IV or general anesthesia could not be used, it would be more comfortable and slightly less costly to use some form of anesthesia for this type of facial implant surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cheek implants, dr barry eppley, indianapolis, paranasal implants, plastic surgery of the face
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Monday, October 11th, 2010
Q: I had Medpor implants placed in the paranasal area several years ago in 2007. It appears that I will be undergoing a LeFort I osteotomy in future. I was wondering whether these implants need to be removed for this procedure and how difficult is it to do so?
A: Paranasal implants are placed around the curve of the pyriform aperture to add fullness under the nostril base of the nose. They help push out the base of the nostrils and are most commonly used to augment a midface deficiency. They are made out of different materials of which Medpor is one of them. This porous material does allow for tissue ingrowth which makes it more difficult to remove than that of silicone, for example. But they can still be removed without a lot of tissue destruction to do so.
A LeFort I osteotomy makes a bone cut directly across the pyriform aperture area. Advancing the upper jaw at this level creates midface fullness, particularly in the paranasal and anterior nasal spine area. (base of the nose) It would be absolutely necessary to remove paranasal implants when performing this procedure. The fullness created by moving the upper jaw at this level makes the need for paranasal implants after bone repositioning as irrelevant.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, LeFort I osteotomy, paranasal implants, plastic surgery
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Saturday, October 2nd, 2010
Q: Do paranasal implants any effect on the length of the upper lip? Do they lengthen the upper lip, what is common with premaxillary implants, or do the paranasal implants rather lift the upper lip a little bit? In one of your You Tube videos about Advanta PTFE facial implants you soaked these implants in an antibiotic solution before they are implanted. Would you similarly dip the Medpor implants in a antibiotic solution also? I noticed that you use both implant materials – silicone and Medpor – and you obviously know the advantages and disadvantages of both very well. I personally would prefer the Medpor implants because they permit tissue ingrowth. But I often hear that Medpor implants are virtually unremovable once they are incorporated. Have you ever removed an incorporated Medpor implant? Is it true that it is extremely difficult to separate the periosteum from the surface of an incorporated Medpor implant?
A: Paranasal implants will not lengthen or push the lip down like a premaxillary implant. Neither will they lift the upper lip either. They merely provide fullness to the nasal base.
I soak all implanted materials in an antibiotic solution. This is particularly valuable in porous implants where bacteria can become trapped into the pores of the implant and not easily washed or rubbed off. The porous nature of the Medpor material also allows an antibiotic solution to be impregnated into the implant with vacuum infiltration or prolonged soaking.
Tissue incorporation into a facial implant is a two-edged sword. It has a benefit of providing anchoring of the implant to the bone site through tissue fixationalthough that advantage can be gained by screw fixation at the time of placement. Removal is definitely more difficult but by no means impossible, particularly for a small anteriorly located implant under the nose. It is more tedious and more tissue disruption must be done to get them out but it is not that difficult.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, facial implants, indianapolis, paranasal implants, plastic surgery
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Wednesday, September 29th, 2010
Q : I’m interested in having paranasal implants and I noticed that you have experience in using these implants. Could you please tell me how exactly these implants effect the nose and the upper lip? Does this implant usually widen the alar base of the nose? Does it lift the tip of the nose, which is common in LeFort I osteotomies? Is the upper lip lifted by these implants or is the upper lip seemingly becoming smaller, because of the new relation between the new volume around the nose and the volume of the upper lip? How does it usually effect the nasolabial angle and how does the upper lip change in the profile view? Are there slightly different ways to place the paranasal implants, for example to place the implants closer together towards the spina nasalis anterior or a little bit more apart from each other? I talked to another plastic surgeon and he said they had the same effects on the nose as the LeFort 1 advancement, but I´m not sure if this is correct, because the position of the spina nasalis anterior is usually changed by performing a LeFort I osteotomy. However, by placing the paranasal implants the position of the spina nasalis anterior stays the same. Also the upper teeth stay in the same position and I wonder what effect this might have on the upper lip.
A: Paranasal implants are placed at the base of the ala along the perimeter of the pyriform aperture. They help fill out the paranasal area but will not create the same effect as LeFort I osteotomy. To do so they have to be combined with a premaxillary implant which sits in front of the anterior nasal spine. They have no significant effect on the size, shape, or position of the upper lip or the nasolabial angle.
For central midface deficiency they can help ‘pull the face forward’ when used in conjunction with cheek implants. They add fullness to the nasal base but will not change nasal tip projection. Over the years, the greatest use of them in my Indianapolis plastic surgery practice is in unilateral cleft lip and palate to help build out the upper alveolar and nasal base deficiency.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, midface deficiency, paranasal implants, plastic surgery
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