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One of the earliest signs of facial aging is in the appearance or increased depth of the nasolabial folds by the side of the nose. It is such a common aging occurrence that the original FDA approval for injectable fillers was in the treatment of the nasolabial folds. Injectable fillers still remain as the most common treatment method now twenty years later. 

While some inject the nasolabial folds in the immediate underlying subcutaneous fat layer beneath the deepest part of their indentation, greater effectiveness has been shown from stacking the filler from the underlying bone upward. This ‘bone push’ of the filler suggests that actual bone augmentation by an implant may also be effective. This is supported by what is observed with the use of standard paranasal implants which provides improvement in the projection of the nasal base but also has been shown to soften the nasolabial folds as well.    

In the March 2023 issue of the Journal of Craniofacioal Surgery an article on this topic was published entitled ‘Patient Specific Implants for Correction of Midfacial Aging’. In this paper the authors evaluated the use of custom computer-designed midfacial nasal base implants for shallow nasolabial folds caused by aging. Their results were evaluated by before and after photographs as well as a wrinkle severity raging scales for changes in the nasolabial folds. Patient satisfaction was evaluated by the global aesthetic improvement scale.

Eleven (11) patients received bilateral custom midface implants made of PEEK material in the nasal base. (22 implants) At four to twelves months after the surgery all implants did well with no infections. The wrinkle severity scale showed good reduction in nasolabial fold severity in all patients. The global aesthetic improvement scale showed an extremely improved nasolabial fold in 28% of the patients, much improved in 64% and improved in 10%. No patient showed lack of improvement in the depth of their nasolabial folds, it was only a matter of the amount reduction seen.

For augmentation of the deepest part of the nasolabial fold the underlying paranasal bone has a concave shape. Thus improving the shape of the paranasal region by bony augmentation makes anatomic sense and it is not surprising that some form of paranasal augmentation is beneficial for softening the depth of the overlying folds closest to the nose. The interesting question is whether custom implants, like used in this study, is absolutely needed for the result. I understand why they did as there are no standard PEEK implants so every PEEK implant must be custom made.  In addition PEEK is a virtually non-modifiable material so you need a custom design to make it fit. I have used standard (silicone, ePTFE) as well as custom paranasal implants over the years and can not say that I see a major difference in their effects. The augmented bony area is small so the most important aspect is to have an implant that provides enough surface area coverage and projection….a custom design is not essential in these materials..

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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