Q: Dr. Eppley, I have a recessed premaxilla even after jaw surgery, and I’m looking to ‘rotate” the base of my nose forward as per the image without increasing the volume at the side of my nose. Just wondering, does such an implant exist, and if not, how much will it cost to have it custom made?
A: What you are looking to do is increase the projection of the anterior-inferior portion of the pyriform aperture area, known as the premaxilla. There is, as you may know, a facial implant known as a peri-pyriform implant. This is really a combined premaxillary-paranasal implant. One could either remove the paranasal portion of the existing off-the shelf implant, hand carve the exact design from a carving block or have a custom premaxillary implant made. It is really all about how much projection (thickness) that the implant needs to have.
The premaxillary implant is placed through an intraoral incision across the lower edge of the pyriform aperture and across the anterior nasal spine of the maxilla in the midline. I would place two micros crews on each small wing of the premaxillary implant to ensure its positional stabilization after surgery.
Dr. Barry Eppley