Do I Need Paranasal Implants or Combined Paranasal-Premaxillary Implants?

Q: Dr. Eppley, I was also concerned about the premaxillary implant increasing the nasolabial angle. However, would this be able to be fixed if the surgeon performs a septal extension graft to reduce the upturned nose? The full surgery would be: donated fascia in tip & bridge, septal extension, and alar base reduction.

Additionally, do you think performing both the rhinoplasty + paranasal implant in one procedure would lead to a more aesthetic result?

Or would paranasal after yield a better result? Im just concerned that without paranasal first, the surgeon may create a nose that is slightly underprojected after the implant is added.

A:In answer to your questions:

1) A premaxillary augmentation is going to fight against the effects of a septal extension graft. How significant that diametric effect is is hard to say as there is the amount of premaxillary augmentation and how much is the septal extension graph really going to drive down the tip of the nose

2) if one is absolutely certain of the benefits of either procedure, rhinoplasty and paranasal augmentation, then you can make an argument for doing them at the same time. However, given your concern about not having stable pyroform aperture base first then you really have answered your own question… do them as a staged approach.

Dr. Barry Eppley

Plastic Surgeon