Q: Dr. Eppley, I am interested in paranasal implants…again. I had jaw surgery five years ago which successfully corrected my under bite, but I still have mid-face concavity. I originally sent you pictures a couple of years ago and you said I was a good candidate for this procedure. A little over year ago I had the paranasal implant surgery done locally, but there were about 3 small tears that opened opened up along the incision line, which lead to infection less than 2 weeks after the surgery. The surgeon offered to redo the procedure after 6 months of healing at a discount, but I didn’t have much faith in him after that.
For the implants, we had selected the larger 7mm porous implants, and it completely eliminated the concavity, and it looked good despite the little bit of swelling that remained.
A:Thanks for providing your paranasal implants history. You obviously had Medpor paranasal implants which I don’t like since they have a higher rate of infection due to their porosity. Paranasal implants are unique amongst facial implants because they have the thinnest soft tissue cover over them being right under the lip. Unless one gets a two layer closure over the implants, which includes a good muscle layer, wound breakdown will occur. It sounds like you probably had a combination of both that lead to an early exit of the implants. Whether the 7mm thickness of the paranasal implants is really adequate is unknown because it really takes up to 6 weeks for all the swelling to be gone. But with your history of prior surgery and now scarred tissues, I would not push it beyond that thickness anyway.
Dr. Barry Eppley