Will Paranasal Implants Cause My Nose To Be Upturned?

Q: Dr. Eppley, I am interested in paranasal implants. I am a young Asian male residing and am looking forward to hearing your experience and expertise in facial deficiencies. I have a slightly retrusive face with deficiency in the maxillary area and slightly in the paranasal area. I am considering doing both procedures. However, I have some questions that I hope you could assist me in answering based on your experience:

1) Can paranasal implants make the nose slightly upturn? ( I’ve seen complaints of such occurrences)

2) Will the paranasal implants cause stiffness when smiling AND change the shape of the upper lip (I’ve seen before and afters and I noticed that the upper lip tend to be thinner). Because even with my slight midface deficiency, everyone says I have a very attractive smile and I am very afraid to risk losing that. ( I would like to change the tired look when NOT smiling but maintain the current smiling face )

3) Will maxillary implant alone reduce the dent in the paranasal area ( beside the nostrils ).

4) Is at grafting and maxillary implant be possible ( and long lasting enough? )

Really hope you could help answer the questions to the best of your knowledge. 

A: When it comes to midfacial implants, let me carefully define the terms, paranasal, premaxillary and maxillary implants. These three implant terms are often used almost interchangeably but they are three distinctly different regions and implants for the midface.

A paranasal implant, which wraps around the lower pyriform aperture area, augments the base of the nose under the nostrils only. (also softening some depth of the upper nasolabial fold seen externally) It does not cross under the base of the nose or under the columella or on top of the anterior nasal spine. Thus, a true paranasal implant will not may the nose upturned. Because it is placed on the bone, under the facial musculature, it does not thin out the lips and has a very low risk of any change to one’s smile. (once beyond the temporary swelling and stiffness that typically occurs in the early after surgery period)

A premaxillary implant, often confused with the paranasal implant, goes across the base of the nose under the columella. (to add to the confusion there are combined paranasal-premaxillary implants) Historically such implants have been placed from inside the nostrils, above the bone and directly into the orbicularis muscle of the lip. It is this premaxillary implant that undoubtably gives rises to upturned nose, stiff lips and altered smiles. While a premaxillary implant can be placed right down on the bone and across the anterior nasal spine from inside the mouth, caution must be given to the size of the implant to prevent these nose and lip problems.

A maxillary implant (and one can argue that the paranasal and premaxillary implants are forms of maxillary implants) is an implant that extends beyond the paranasal area across the face of the maxilla and then sits just under the cheek bone. It is a rarely used implant as it has a midfacial volumizing effect between the base of the nose and the cheek prominence.

As you can see by these proper descriptions, it is easy to confuse the effects of these midfacial implants.

Dr. Barry Eppley

Indianapolis, Indiana