Am I a good candidate for a pyriform aperture implant or malar implants? (photo)

Question

I am getting a 3rd revision rhinoplasty soon to correct the septal deviation and nostril assymetry of my nose. I have mild hypoplasia w/ underdeveloped maxilla, my cheeks are flat and I have prominent nasolabial folds and little to no tooth show for a female. I want to also get malar implants to build up on my skeletal deficiencies, can anyone help to recommend sizes and whether I need malar/submalar or a combination? Also, would I be a good fit for a pyriform aperture or paranasal implant?

Alejandro Nogueira, MD · Answer

I must kindly disagree with the suggested plan; to begin with the premaxillar implants around the pyriform aperture are very bad option, in general lead to poor, nulll or weird result and this explains why they are not a popular treatment; don't get them.Secondly; I understand from your message you deem your cheeks flat or underdeveloped, and you attribute this fact to the lack of development of your facial skeleton, thus your idea is correcting this with malar implants; all the former assumptions are not correct. I will no enter to discuss if your cheeks are underdeveloped or not, but I can professional confirm to you that the cheeks are formed without any bone contribution to their shape, they are exclusively flesh without any supportive bone or cartilage, therefore there are no such "cheek implants".Cheekbone implants or malar implants pose a serious terminological risk to patients, the idiomatic issue comes for the lack in English language to a clear term for the cheekbone; the "cheekbone"... is not at the cheek! in other languages, for example in my native Spanish, we have "pómulo" to differentiate from "mejilla" (cheek) as two distinct facial areas; the cheekbone is not at the cheek and thus cheekbone implants do not enhance or make any effect on the cheeks.Furthermore, your cheekbones or malar bones, located midway between the orbit, the temple and the ear, are well prominent and augmenting them with implants would be an aesthetic error.Additionally, the nasolabial folds are not treated with implants.In order to feminize your facial features and look more balanced I strongly recommend a feminization genioplasty, to make it less boxy, rounder and smaller according to the rest of the face, a two or three dimensional reduction genioplasty (not shaving it, ever!).Your rhinoplasty is a very good but medium-high difficulty case, you need high end structure rhinoplasty techniques, including alar batten grafting to treat the evidente nostril / alar valve collapse when you express yourself or breath in with powerful flow, trimming the alar flare and intensive tip work to achieve a perky and chiseled one (tip plasties / grafting).See the link below to find a case of my own practice very similar to yours, a female seeking nasal and chin feminization, which I had the opportunity to operate successfully on, sharing a lot of common features with the technical problem you have posted.
If you wish better grounded opinion well lit, focused and standard images have to be assessed: frontal, both lateral and both oblique views, also from underneath.
Feel free to request any additional information from me.

Suleyman Tas, MD, FEBOPRAS · Answer

Hello, thank you for question and shared photos, Based on them you can benefir chin implant that will help to balance your face.By a Rhinoplasty operation you can have well proportioned, natural, symmetrical look that matched with your desired overall face, by Closed and Atraumatic technique you can have maximal healing, minimal edema&swelling and no scar on your columella.Regards,

Toby Mayer, MD · Answer

In my opinion you do not need a pyriform aperture implant. This area looks normal. You would benefit from cheek implants. These come in different sizes which you and your surgeon can discuss and choose which is appropriate for your face.  see several very experienced cheek implant surgeons who can show you excellent before/after results without an overdone look. These are placed thru a small incision inside the mouth  The rare complication of infection is possible but the most Common complication in my opinion is using implants that are too large to look natural.

Jesse E. Smith, MD, FACS · Answer

It is likely that you think that your malar eminence is flat. However, if you look at the vertical thirds of your face your chin is slightly short. The nasolabial folds can easily be corrected with volume. Your face is slightly elongated. Because of this, it would behoove you to add slight volume to the lateral malar eminence which would address the lack of volume in the upper middle third of the face. This could be done by two methods. One, as you suggested, would be the malar implant and the second would be a fat transfer. The fat transfer could also add volume to the nasolabial fold. I agree that nasolabial implants are likely not a good solution for you, or hardly anyone. I would strongly suggest the autologous fat transfer. Malar implants tend to become recognizable after 10-15 years of use.

Ronald V. DeMars, MD (Retired) · Answer

Ask a group of plastic surgeons a question and you are bound to get a selection of opinions. Malar augmentation, in my opinion, would look great on you. Size cannot be chosen without an exam. I've been doing this procedure with small incisions in the mouth for decades with excellent results and very happy patients. It creates the look in your cheek that you achieve with a 1/2 smile when you bring some of the lower volume higher onto the cheek. It's a safe, short operation with quick recovery.

Am I a good candidate for a pyriform aperture implant or malar implants? (photo)

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