Will The Effect Of A Custom Midface Implant Be The Same If I Pull My Nose Forward?

Q: Dr. Eppley, I have two questions, one relating to the custom midface implant and one about the custom wraparound jaw implant. 

1. When I put my fingers in my nostrils and pull my nose forward, I really like the “tightening” effect of the area around my nose, and I presume the implant will permanently realize this effect. But I also like how the width of my nose significantly decreases, and the columella also lowers in the frontal view. Will a midface implant replicate the effect of pulling out the bottom part of the nose and the subsequent decrease in nose width as well as slight lowering of the columella relative to the nostrils, or will there just be an increase in the projection of the nose as a whole without any frontal changes (excluding the tightening effect)? 

2. When you do a custom jaw implant, is it possible to advance the labiomental fold through fat grafting within the same operation?

A: In answer to your questions:

1) In regards to a midface implant the answer is yes and no. With your manual maneuver you are externally pulling the nose forward. (traction) Conversely an implant works by an internal pushing effect. Those do not create exactly parallel effects on the overlying soft tissues. A midface implant will push the base of the nose forward (pyriform aperture) which will make the tissues feel tighter. But it will not cause nostril narrowing, lowering of the columella or an increase in nose tip projection. Those effects can be created but would require separate rhinoplasty procedures to simultaneously accomplish.

2) Fat grafting is the adjunctive technique need to reduce the depth of the labiomental sulcus whether it is an isolated chin implant, sliding geniopasty or a custom jawline implant.

Dr. Barry Eppley

Indianapolis, Indiana