Q: Dear Dr. Eppley, I am interested in both malar and paranasal implants and I have learned a lot about facial implants on your homepage! In one article you stated that some areas in the face are more sensitive to implant size than others. For example, the orbital rim is one of these areas where the size of implants have to be chosen very carefully because 1 mm can make a huge difference. I guess it is the opposite with paranasal implants because (although they can be tailored) they are only available in such big sizes like 4.5 mm and 7 mm. I am not sure if I should choose the 4.5 mm or the 7 mm implant, but I am sure that I want rather a more dramatic look than a very subtle outcome. Do you think 2 mm difference in the paranasal area can make such a huge difference? Is the paranasal area more tolerant towards a slight overcorrection? Is my assumption, that paranasal implants are less sensitive to size, right? The worst thing that could happen to me after the implantation of the paranasal implants would be an increase of my nose tip projection, an increase of my nasolabial angle and a lengthening of my upper lip. Of course I know that paranasal implants usually don´t do this, but I am a little bit afraid that this could be different with the large 7 mm implants. Have you ever implanted the 7 mm paranasal implants and what are your experience with patient´s satisfaction? Did they rather wish to have more or less projection after they saw their final paranasal implant result?
A: The paranasal area is less sensitive to implant size for a variety of reasons. The first is that the skin around the base of the nose is thick so implant thicknesses are easily masked. A paranasal implant also has to push the base of the nose (nostrils) outward so it takes a bigger implant to do that. Lastly the surface into which the implant is placed is curved inward and not outward, further decreasing its influence. In general, small paranasal implants placed at the bone level has little effect so thinking bigger (7mms or more) will have a more visible effect. I don’t recall using a paranasal implant that was ever smaller than 7mms at its thickest portion.
A paranasal implant has no influence on the projection of the nasal tip, regardless of size. Only when a premaxillary implant is placed across the anterior nasal spine will it change the nasolabial angle with a small influence on the nasal tip.
Dr. Barry Eppley