Do I Need Premaxillary or Paranasal Implants?

Q: Dr. Eppley, Thank you for the knowledge you publish on your work. I’m a 24 year old male from Washington DC. I’ve read your answers regarding paranasal implants and premaxillary implants closely to determine what could be the best procedure for my sunken in midface, protruding mouth, acute nasolabial angle, and an upper lip that protrudes beyond the lower noticeably (picture attached). I am concerned that as I age, the upper lip/philtrum will continue to get longer, and due to the acuteness thus contribute to even more protrusion? I am wondering if you can comment on that as well! 

I have no malocclusion (had braces + 4 extractions). I originally thought paranasal implants would be appropriate to make a concave midface, which would increase the nasolabial angle/hide mouth protrusion.

However when I found your readings it seems the premaxillary implant, different from paranasal, is best for my situation. I am concerned that a premaxillary implant may make my upper lip protrude further past my lower lip, even if it opens up the nasolabial angle. I am also aware of the risks such as the effect on the smile. 

I’m hoping if you can comment whether this path might be appropriate for my protruded mouth situation, and on the concerns of it advancing the upper lip even further past the lower.

A: Thank you for your inquiry and detailing your midfacial augmentation objectives. I am at a major disadvantage when trying to answer your questions since I have no idea what you look like. A description alone is inadequate. In addition the way any facial reshaping procedures are determined is by computer imaging of the patient’s pictures of the various potential changes. As a result any meaningful insight I could provide requires pictures to do these assessments.

Dr. Barry Eppley

Indianapolis, Indiana