One type of facial implant, and a facial area that can be augmented, is the paranasal area which most have never heard of. The paranasal region is the area just to the side of your nose at the wings of the nostrils. This is an area that is supported by the bone above the front and canine teeth. I became very familiar this area in treating cleft patients where on the side of the cleft the paranasal region was always deficient and sunken in. I frequently built this area back up with bone grafts or implants as an older child or teenager when I did their reconstructive rhinoplasty (nose ) surgery. From this experience, I observed how building out this area affected the face.
Cosmetically, some patients have an overall middle of the face deficiency as the upper jaw is a little short and they have flatter cheeks. Other patients have more ideal facial bone development but, as they age, the overlying nasolabial folds become ‘deeper’ as the cheek tissue descends and falls over the more fixed upper lip tissue. In either case, the use of paranasal implants may be aesthetically helpful.
Paranasal implants are very small implants, about the size of a quarter, that are placed on the bone right up against the pyriform aperture through a small incision up under the lip. What is the pyriform aperture you ask? If you look at a skull, you will see the nasal passages in the middle of the face. The lower end of this large opening down near the upper teeth is known as the pyriform aperture. You can easily see the bone right next to them which slopes away. By building up this area, you increase the fullness under the side of the nose.
Paranasal implants, while not commonly done, can be useful as an overall strategy with cheek implants to build out the middle of the face or to help soften the deepest end of the nasolabial fold near the nose.
Dr. Barry Eppley
Indianapolis, Indiana