Q: Dr. Eppley, I’m looking to get augmentation to the base of the nose (the area directly below the bridge/nostrils) to ‘rotate/push’ it forward as seen in the picture. (per maxillary augmentation) I’ve seen pictures of paranasal and peri-pyriform implants, but those involve augmentation of the sides of the nose, and that’s not something I do not want.
Can I check if my aesthetic goals are possible, and if so, what options are available for doing so? I understand that you do custom designed implants, but are there any off the shelf alternatives to those?
Additionally, could fillers be used in the interim to simulate what an implant would do? This is something I would like to consider to see if I would like the augmentation before proceeding with a more permanent implant.
A: First, what you are trying to augment is the nasolabial angle or the nasocolumellar-upper lip junction. This is more commonly referred to as the central premaxillary region or the anterior nasal spine specifically. This has been done fro decades using a wide range of materials from autogenous materials like cartilage and bone to allogeneic materials like irradiated cartilage to a wide range of synthetic msterials. (e.g., Gore-tex, mersilene mesh, silicone implants) They all can work in such a small area. There would certainly be no reason to make a custom implant for this small areas. Whatever the implant material would be it would be ‘custom made’ or hand fashioned at the time of surgery out of any of these materials.
You can certainly test the benefits of premaxillary augmentation by using any of the injectable fillers. They may not create exactly the effects of any implant material which would have more of a push on the overlying soft tissues than softer injectable filler materials.
Dr. Barry Eppley