Q: Dr. Eppley, Three years ago I had a functional rhinoplasty with adenoids were removed and turbines shrunk which has dramatically changed my voice. My nose and face have changed. The flesh all around my nose, the triangle from under my eyes down my cheeks and under my nostrils / tip of my nose has completely sunk. It is fixed and depressed against the bone of my skull. My top lip has flattened and hangs lower over my teeth. The nose tip is also thinner and lower. I am interested in a pyriform implant a surgeon here recommended that might support the base of the nose off of my skull again and lift the flesh up with it. It is a concave depression right now I keep poking out with my tongue over my teeth. Also my cheeks have sunk either side of the nose so I have folds and have lost my natural volume over my naturally high check bones. I had a young face but have aged over night. My eyes look sunken and everything pulled down as if the implants fixed my cheeks inwards and down. I have seen different surgeons and there is no consensus between implants or fat grafting but I also feel as if my cheek and lip muscle around my nose need lifting back into place. I keep being told I am attractive and too young for a face lift. I feel as if no one is listening. I seem to be researching similar treatments as cleft palate patients. Between the nose and lip and around the nostrils up to the eye are indented.
Please find attached some pictures for your review. You can see how my lips jutting out under the lip and the front of the cheeks is flat, particularly indented on either side of the nostrils and where the mouth cheek folds are. I look forward to hearing from you.
A: Thank you for sending all of your pictures. You have a classic central midface deficiency. It is really a combined per maxillary-paranasal-maxillary deficiency which is commonly seen is certain ethnic groups. (e.g., Asians) The whole central part of your face is flat. While a peri-pyriform midface implant will be somewhat helpful it is inadequate in both design and size for your needs and its benefits alone will be woefully inadequate. By itself it will not provide fullness (more like bumps) to the side of the nose. What you ideally need is a custom midface implant made that will build up the entire deficient mid facial area from around the base of the nose up along the sides of the nose and out onto the maxilla. In addition the tip of the noses not going to be lifted up by any augmentation done at the bone level including the premaxillary region. Deprojection and lifting of your nasal tip will require a tip rhinoplasty to do so.
Dr. Barry Eppley