Hoe Can I Restore My Wide Nose After Midface Implants?

Q: Dr. Eppley, Last year I had a malar and premaxillary implant put in as I had a very sunken face from previous pr molar extractions. My surgeon promised me that this would not have any effect on my nose and that if I didn’t like it I could remove them and everything would eventually go back to pre operative state.The implants completely further destroyed my face and really made my nose look wider and thicker so I took them out 4 months after. Now 13 months after I am devastated over how my nose is completely destroyed. I had the most perfect nose and I was very particular about not wanting any changes to my nose and if that would be the case i wouldnt want to proceed with the surgery. The surgeon further reassured me that it would not have a negative effect and would just serve as a filler in the area. The surgeon is gaslighting me telling me that he has not touched my nose during the procedure and that he doesn’t know what happened to it. He has been very strange with different answers and even stopped to answer me completely at one point. I don’t know where to turn for answers since he refuses to give me answers. Since he removed the implants e hasn’t even cared to invite me back to the office or take a look at my nose once and he just keeps saying that he doesn’t know what happend. I have only managed to find answers on your website so far and I am devastated to see that for this procedure you have to in fact detach the nose on several places to fit the implant and my surgeon just won’t admit to it. Please help me, what can I do to get my nose back?

A:In any form of intraoral midface surgery, whether it be a LeFort osteotomy or a midface implant where a complete soft tissue degloving from the bone is needed, there can be some potential changes to the nose particularly that of the nasal base. (premaxillary-paranasal area )  The nostrils can become wider as the soft tissues have become detached and retracted. This potential anatomic issue has been known for decades and is why a variety of protective procedures during closure from these procedures have been employed to try and prevent these adverse nasal base changes. (e.g., alar cinch suture, V-Y musculomucosal closure) Even in ‘simple’ paranasal implants the nostrils have been shown to increase in width by 1 to 2mms.

Postoperative management of the wide nasal base can be treated by external nostril narrowing techniques or even inraoral cinch sutures. Ironically they are more effective when combined with some pyriform aperture augmentation…even though that was the original source of the problem. (the soft tissue degloving was not the implant per se)

Dr. Barry Eppley

World-Renowned Plastic Surgeon