What Is The Best Material For Premaxillary Implants?
Q: Dr. Eppley, I had a rhinoplasty several years ago that changed the angle of my nose from convex to acute. I would like to have this corrected with a premaxillary implant. Do you prefer silicone, mersilene mesh or hydroxyapatite?
A: Thank you for your inquiry and good question. While arguments can be made for any of the materials you have mentioned, and I have used them all, I prefer mersilene mesh in the premaxillary/pyriform aperture area. While I don’t use this material for most other facial areas, it has several advantages under the base of the nose including easy shaping and fabrication, no need for implant fixation, rapid tissue ingrowth with firm fixation and minimal palpability to the touch. Silicone implants tend to be a little firm and placing them under the thin mucosa of the maxillary vestibule makes them prone to future problems of tissue thinning, exposure as well as palpability. Hydroxyapatite granules is another reasonable alternative as a good long-term facial implant material. Its only problem is that one does not have ideal control over the placement of the material and the granules do settle out so the amount of premaxillary augmentation may not be enough or may be uneven or irregular.
Dr. Barry Eppley
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