Your Questions

Q: Dr. Eppley, This is for the nasal sill area and I am specifically interested in the cartilage injections to augment the sills which were removed in a bullhorn liplift. Will the injectable cartilage work for this indication? I would like to take care of that first since it can be done under local. What would be the price for cartilage injection in the sill area?

 The other procedure for premax augmentation don’t you also use mersilene mesh to augment that area or do you just use rib? I think rib might be better anyway except I would be afraid of warping.

A: If your goal is to try and stretch out skin in the nostril sill area, I don’t think this will work with any form of subcutaneous augmentation. It may provide a push but I can’t see how that will make up for lost skin along the nostril sill. In addition, placing injectable cartilage can not be done under local anesthesia. While the injections could be done under local, the cartilage must be harvested usually from the nasal septum which is not a local procedure. One simple way to easily prove whether an injectable approach will worko is to first have a temporary filler like Juevderm or Radiesse injected and see if that works. If it is successful then you can move forward with injecting cartilage.

Mersilene mesh can certainly be used for premaxillary augmentation just as rib can. I would have no concerns about rib warping as that is a function of how it is harvested so it is easy problem to avoid in an enbloc augmentation application.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, do you do injectable cartilage? Can this be used to give support in the nostril sill area? My sills were partially removed from a bullhorn lip lift and I thought the cartilage injections might rebuild the area. Dr. Onor Emrol in Istanbul says the injectable cartilage can be used in this area but I can’t really travel that far and he doesn’t do phone consults. I have scarring at the base of the nose loss of nostril support from the liplift and the sills were partially removed due to where the incision was placed. Also can the injectable cartilage be used to do premaxillary augmentation. I want to move forward the nasolabial angle. The nasolabial angle is now caved in due to being scarred down from the liplift and I need to increase the angle push it away from my face.

A:  I have done numerous diced cartilage grafts, whether it is by injection or with a rolled graft fabrication in fascia or surgicel collagen material. The key questions are whether such cartilage grafts will work for your two indications and what volume is needed. From a premaxillary/paranasal augmentation standpoint, the issue with using cartilage is the volume of donor material needed. The septum will not have enough material to create enough push to make a visible difference in these areas. To get good volume, a lower rib donor source is needed where a good bloc can be removed and used. Whether one dices up the cartilage or injection below the skin and places it at the bony level in a carved form just like a synthetic paranasal-premaxillary implants is a matter for further discussion. From a nasal sill standpoint, the septum or ear will offer enough material to dice and injected beneath the scarred nasal sill area. While this will not replace lost skin that was removed from the lip lift, it will provide subcutaneous volume to push out on the area.

Dr. Barry Eppley

Indianapolis, Indiana