How Do Paranasal Implants Change The Face?

Q : I’m interested in having paranasal implants and I noticed that you have experience in using these implants. Could you please tell me how exactly these implants effect the nose and the upper lip? Does this implant usually widen the alar base of the nose? Does it lift the tip of the nose, which is common in LeFort I osteotomies? Is the upper lip lifted by these implants or is the upper lip seemingly becoming smaller, because of the new relation between the new volume around the nose and the volume of the upper lip? How does it usually effect the nasolabial angle and how does the upper lip change in the profile view? Are there slightly different ways to place the paranasal implants, for example to place the implants closer together towards the spina nasalis anterior or a little bit more apart from each other? I talked to another plastic surgeon and he said they had the same effects on the nose as the LeFort 1 advancement, but I´m not sure if this is correct, because the position of the spina nasalis anterior is usually changed by performing a LeFort I osteotomy. However, by placing the paranasal implants the position of the spina nasalis anterior stays the same. Also the upper teeth stay in the same position and I wonder what effect this might have on the upper lip.

A: Paranasal implants are placed at the base of the ala along the perimeter of the pyriform aperture. They help fill out the paranasal area but will not create the same effect as  LeFort I osteotomy. To do so they have to be combined with a premaxillary  implant which sits in front of the anterior nasal spine. They have no significant effect on the size, shape, or position of the upper lip or the nasolabial angle.

For central midface deficiency they can help ‘pull the face forward’ when used in conjunction with cheek implants. They add fullness to the nasal base but will not change nasal tip projection. Over the years, the greatest use of them in my Indianapolis plastic surgery practice is in unilateral cleft lip and palate to help build out the upper alveolar and nasal base deficiency.

Dr. Barry Eppley

Indianapolis, Indiana