What Is The Best Method To Improve Nasomaxillary Projection?
Q: Dr. Eppley, I have a question about midface (nasomaxillary) projection. My nose(practically entire mid-face) from profile looks quite flat and my cheek line” from profile is almost vertical. I would prefer to have a nose that projects more and a more sloped cheek line. In the book “Aesthetic Surgery of the Craniofacial Skeleton: An Atlas” I read about some osteotomies that advance fragment of nasomaxillary complex and advance it forward and counterclockwise (but I don’t know if such procedures are performed on a regular basis.
Traditional bimaxillary surgery won’t bring the nose forward so its not really an option. Below I attach pics of my nose, what I meant by cheek line and desired midfacial side profile.
Thank you very much for answer.
A: Thank you for your inquiry and sending your picture and detailing your concerns and objectives. It is esay to get caught up in facial osteotomy designs on drawings and assuming that is the best way to address their facial concerns. In reality these osteotomies have their place but when it comes to increasing the projection of the nose on an otherwise flatter midface this would not be an effective method to do so. (nasomaxillary augmentation)
First you have to define exactly by what you mean by ‘increased nasal projection’. This could entail one of two meanings…increase the projection/fullness of the nasal base or improving the projection of the dorso-columellar line of the external nose. I am going to assume you mean the former since you have described your own lack of midface projection and have been looking at osteotomy approaches to improving it. In that regard it is far more effective and surgically less complicated to adding to the flatter midface, specifically around the bony pyriform aperture around the base of the nose. This onlay augmentation can be done by bone/cartilage grafts, bone cements and custom implant designs. There are advantages and disadvantages to all of these onlay midface augmentation approaches which requires a more detailed discussion.
Dr. Barry Eppley