How Close Can Paranasal-Premaxillary Implants Come To What A LeFort I Osteotomy Can Do?

Q: Dr. Eppley, I am interested in paranasal-maxillary implant because of the lack of support and projection I have in my midface, specifically around my nose and in my upper lip/philtrum. I was looking into Lefort 1 orthognatic surgery, as I do have a very slight Class 3 malocclusion, but both surgeons and orthodontists discouraged me because it’s very mild. The issue is I still struggle with this lack of support, my midface kind of sinks in when I smile, my nose drops (even after two rhinoplasties) and my upper lip flips in a horizontal line over my philtrum. I also dislike the proportion of my nose in relation to my face, and the prominent nasolabial folds, at only 24 yrs old. The question i’m asking is can a paranasal maxillary implant create similar results in soft tissues as a Lefort 1 advancement ? I understand the osteotomy is probably way more dramatic in inducing a change, but could the results be similar?

A: The fundamental differences between a LeFort I advancement osteotomy and nasal base implants (paranasal-premaxillary-maxillary) is at the dental level. A LeFort I osteotomy can push out the upper lip as the lips rests on the upper teeth. So any forward dental movement  (the LeFort I bone contains the teeth)mwill push out the vermilion of the upper lip as the bone moves forward. The effects of implants is relegated to all of the bone above the dental level. That being said in the description of your symptoms most if not all of them could be improved by nasal base augmentation.

Dr. Barry Eppley

World-Renowned Plastic Surgeon