Will A Premaxillary Implant Fix My Flaring Nostrils When I Smile?
Q: Dr. Eppley, I had a closed rhinoplasty in 2015. The surgeon did a good job but its not perfect. My columella is cooked and my nasal tip points down. My facial muscles are also very strong and make my nose very wide when I smile. I am hoping this can all be repaired with a premaxillary implant.
Please review the attached pictures and let me know what you think.
A: Thank you for your inquiry and sending your pictures to which I can say:
1) The purpose of a premaxillary implant is to bring forward the recessed lower pyrifom aperture area which your pictures show would be of benefit as evidenced by your less than 90 degree nasolabial angle.
2) Such a midface implant would work in conjunction with a secondary tip rhinoplasty to bring increased tip rotation through caudal septal resection, lateral crural spanning sutures and infratip cartilage resection. Straightening of the crooked columella along with augmentation of the collapsed right alar rim requires a septal graft harvest for the cartilage needed to do so.
3) The dynamic nasal flare that occurs with smiling is not the purpose of the premaxillary implant nor will it address that issue by itself. The placement of bi-alar spanning suture between nostril bases MAY provide some improvement in that regard. The other option is to place a microscrew in the lateral aspect of the premaxillary implant and place a permanent suture between it and the nostril base above.
Dr. Barry Eppley