What Is The Best Synthetic Nasal Implant For My Nose?
Q: Dr. Eppley, I am interested in getting my nose built up. I think it is too small. I really don’t want to have a rib graft taken so I am looking at synthetic implants. I am trying to decide between a Voloshin and a Shirakabe nasal implant. Does a Voloshin or Shirakabe implant give a more streamlined appearance? Which implant enhances the nasal tip more? Is the Shirakabe Nasal tip too narrow? Secondly,what is the purpose behind using the Brink Peri-Pyriform Implant in rhinoplasty?
A: The fundamental difference in the Shirakabe nasal implant from that of the Voloshin is that it provides some augmentation to the base of the nose. But that is irrelevant if one is going to have a peri-pyriform (premaxillary) implant. The Shirakabe tip is a morenarrow, particularly across the tip, compared to the Voloshin. One thing you have to be very careful of is to not make the entire nasal tip cartilages (dome) completely covered by the implant. While one can get away with big sizes in facial implants that are covered by muscle, the risk for implant problems (infection, extrusion) that are covered just by skin (such as the nose) is not so foregiving. So I would not get hung up in trying to give the nasal tip too much projection with an implant. That places the skin under tension and is a setup for the aforementioned problems. If one wants to push the envelope of size and tissue tension in the nose, it is far better and less risky to do this with a rib graft.
The purpose of the peri-pyriform (premaxillary) implant in rhinoplasty is to build out the base of the nose in cases of midface deficiency and a smaller nose. This opens up the nasolabial angle, increases the fullness of the upper lip and pushes out the base of the nostrils. This in effect creates a pulling out of the nasal base.
Dr. Barry Eppley