Will A Premaxillary Implant Give Me A Longer Nose?
Q: Dr. Eppley, I saw a topic on premaxillary implants on your website and I am really interested in it. I am wondering whether this can be done separately with & before my revision rhinoplasty? In fact, the result I’m trying to achieve as a before-after is in the first attachment (not the second one, that is just an over exaggerated example). I have consulted one plastic surgeron but he seems to be working primarily on the “nose” itself instead of the surrounding area(s). I am trying to get a bigger nose, and more precisely speaking, I think the reason my last rhinoplasty was failed was because the doctor doesn’t know this internal area; he was trying to achieve the result just by pulling the nose itself outward which is laborious to the skin itself.
A: Premaxillary implants have been around for years and were initially developed to open up an obtuse or recessed nasolabial angle. (as your first illustration image demonstrates albeit extremely so…this must be a photoshopped image not an actual surgical result) There were developed to be used in conjunction with rhinoplasty surgery and were inserted into the subcutaneous space through an intranasal incision.
As the technique of premaxillary augmentation has evolved, it is clear it needs to be placed on the bone in a subperiosteal location. This is well below the lip muscles and soft tissue so as to not interfere with lip and mouth movement. (otherwise it can cause a blocking effect to the lip when one smiles) This also gives the opportunity to create more of a ‘LeFort I’ or maxillary advancement effect to the base of the nose if the implant design and size is sufficient.
Dr. Barry Eppley