Q: Dr. Eppley, The rib graft in premaxillary augmentation can change the smile or make the lip longer? Also would the implant be placed on the bone or in the soft tissues at base of nose? I read on one of your replies that it can be placed either way. Where would it be better in my case? I have heard that a lot of people get the premax or paranasal implants removed because they are too bulky and change the smile. Do you have a way of avoiding these problems. It seems like a rib graft would be big and then it might not be subtle.
A: A solid carved rib graft for paranasal or premaxillary augmentation is placed in a subperiosteal position on the bone. It needs to be skillfully carved to shape and not be too big. I have never seen it change the smile. It may have a slight chance of making the lip a little longer depending on its size. Diced or injected cartilage is placed under the skin and well above the bone, it is a subcutaneous implant material for premaxillary or paranasal augmentation.
Dr. Barry Eppley