What Paranasal Filler Options Do I Have, Such as Bone and Tissue, other than an Implant?

Question

I have some obvious sinking in the paranasal area due to bone loss and perhaps tissue loss too. I wish to avoid implants and wondered whether bone fillers such as hydroxyapatite or tissue fillers would improve my appearance. Also what type of fillers would be the most suitable?

Jeffrey Epstein, MD, FACS · Answer

The ideal approach for your scenario would probably be the use of Radiesse, a long lasting filler for facial augmentation.

Aaron Stone, MD · Answer

I personally prefer paranasal implants but my patients prefer injectable fillers so that is what most of them get. Your options for a filler include your own fat injected into the area, radiesse and sculptra. I prefer these over hyaluronates like Juvederm because they last longer and the filling is at a deep level whichis the ideal plane for these fillers.

	You can see an example of Radiesse in the referenced web page.

	I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

	My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Barry L. Eppley, MD, DMD · Answer

When considering paranasal augmentation, the choice would be between an injectable approach versus an actual only graft augmentation. While there are numerous common synthetic injectable fillers available, none of them will have a permanent effect. If it is an injectable approach you seek, I would use either hydroxyapatite or HTR granules which can be 'injected'. This is not done in the typical percutaneous approach through a fine needle. Rather it is done through an intraoral incision and placed on the bone around the pyriform aperture at the nasal base. The granules or beads are packed into a syringe but are only injected through the open end of the barrel of the syringe so it requires an incision and some limited subperiosteal pocket dissection. This will be very stable in volume and develop good tissue ingrowth. From a graft standpoint, small onlay rib grafts taken from a very small incision at the bottom of the rib cage will also work well and will not resorb unlike bone.

Francis R. Palmer, III, MD (retired) · Answer

Photos, of your face, would be helpful in any futher evaluation but I use the following fillers for facial augmentation Perlane, Radiesse and Sculptra. Each has certain benefits depending on the exact goals to be achieved.

What Paranasal Filler Options Do I Have, Such as Bone and Tissue, other than an Implant?

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