Premaxillary Implant with Rhinoplasty? (photo)

My surgeon suggested i get a small premaxillary implant along with rhinoplasty to give the tip of my nose the projection it needed along with "filling out" my midface. I have a few questions and concerns regurding this. 1. will it effect my smile 2. will i or my partner feel the implant 3. will it be noticable to others ( i dont want it to be) 4. are there any negative side effects 5. how will it look as i age 6. are the results normally good?

Doctor Answers 12

Consider the "Kotler Saline Demo."

The best way to see the future outcome is the "Kotler Saline Demo" test.  That is a sterile saline solution injection given by the doctor to "plump up" the area in question and mimic the effect of the permanent and solid premaxillary implant.

I believe that you will see that it will not affect your smile.  Per se, the nasal implant should not be noticeable to others.  When the implant is placed properly, there should be little in terms of negative side-effects.  As you age, there should not be any negative consequences of having had the implant placed.

I would further suggest that you have your prospective plastic surgeon show you the implant that would be placed.  You can feel it and get a sense of it.  If he shows you the implant or performs the "Kotler Saline Demo" technique to demonstrate the outcome, I think you will be comfortable with proceeding. 

Generally, it is a safe and effective technique as part of a rhinoplasty.

Robert Kotler, MD, FACS
Facial Plastic Surgeon

Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 86 reviews

Premaxillary Implants and Rhinoplasty

Thank you for the question and the picture. It is very rare to need a premaxillary implant during a cosmetic rhinoplasty. Generally speaking, these implants augment the central portion of the midface and can help with deep depressions in this area. They do not provide nasal tip projection or support. Appropriate techniques to increase the tip projection can be performed by manipulating the tip cartilages and the septum. If the angle that the nose makes with the lip is too sharp, the too can be changed without implants by placing a small cartilage graft at the base of the nose. Best of luck!

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 110 reviews

Premaxillary implants

It is a bit hard to tell from your photo since it is not a direct profile view, but I don't really think a pre-maxillary implant is necessary in your case. By utilizing your septum to support your tip and give you a bit of upward rotation, an implant would not be necessary in my opinion.  At the very least, I would get another opinion in person.  Make sure the surgeon you see does lots of rhinoplasties.

In answer to your questions:

  1. it could affect your smile because it may change the way your lip moves over the area of the implant
  2. you should not be able to feel the implant but that would certainly be a risk
  3. it should not be noticeable, but again, might be possible
  4. side effects like infection, extrusion, bone resorption are possible with artificial implants.
  5. hard to know
  6. results are like anything - if done properly on the proper patient, results can be good. 

Matthew Bridges, MD
Richmond Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

Ask your surgeon

This question should only be posed to your surgeon.  Only he or she knows exactly what they will do.  Do not listen to any other surgeon because you don't know whether they do the procedure differently than your surgeon.  If you do not trust your surgeons advice, go and find another surgeon.

Steven Teitelbaum, MD
Los Angeles Plastic Surgeon
4.6 out of 5 stars 48 reviews

Rhinoplasty and facial implants

Based on your limited photo, I would not recommend a premaxillary implant. Your goals of a natural and esthetically pleasing Rhinoplasty result can be achieved with a well performed Rhinoplasty techniques utilizing your own cartilaginous structures. To assess your overall facial proportions and the appropriate implant use would require an in person evaluation. Make sure that you communicate your goals to your surgeon thoroughly, and that your surgeon is experienced in all the techniques that would be required to achieve those goals.

Boris M. Ackerman, MD
Newport Beach Plastic Surgeon
4.7 out of 5 stars 56 reviews

Premaxillary Implant with Rhinoplasty?

     If you send an email through the website listed below, pictures can be sent in a followup email.  Premaxillary implant may be more of a problem than a solution.  Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Premaxillary implant and rhinoplasty

A premaxillary implant can be composed of either patient's own natural tissues such as cartilage or synthetic Silastic material. Each have their own advantages and disadvantages. A premaxillary implant will only give  projection to the nose, not the cheek area. For maxillary retrusion, cheek implants are required. Please see the link below for a patient we have performed a premaxillary implant and rhinoplasty in our practice

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Rhinoplasty with Premaxillary Implant

The role of a premaxillary implant is to add some fullness or projection across the base of the nose. It's primary benefit is not to lift the tip of the nose for if that is needed there are much better tip rhinoplasty techniques to accomplish that goal. Whether you 'need' the implant depends on the fullness of your midface and without pictures that question can not be answered here. How the implant would feel and whether it may affect your smile depends on where it is placed (at the bone level or just under the skin) and what type of implant material and its size is used. These are very specific questions you need to find out from your surgeon before your implant-related questions can be answered.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Rhinoplasty with Pre-Maxillary Implant San Diego

You are wise to seek advice before proceeding.  Your questions beg absolute answers, yes or no, perhaps with elaboration.  In reality, the answer to all of your questions is MAYBE, or difficult to say.  Nobody can predict the future, or be sure who among all patients having a given operation will develop complications.  If indications are proper, selected implant is appropriate size, shape, and composition, insertion technically flawless, and nothing unpredicted happens, the implant will help correct what is likely maxillary deficiency of the nasal sill area and/or upper nasolabial folds, it will enhance your smile, will not be felt or noticeable to others (except by making you prettier), and will improve your appearance for life.  If any of the above elements of planning or execution are imperfect or if you get unlucky, complications and/or problems may develop.  As suggested by other responders, for more specific answers, more information, especially graphics, are required.  A case with pre-maxillary implant is shown in the link accompanying this response.

Steve Laverson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 46 reviews


It is impossible to make any comments about your case without photos or and in-person exam.  Generally, tip projection can be accomplished by adding material to the columella (the center strut giving support to the nasal tip) or by a premaxillary implant.  If the bones of the premaxillary area are deficient, then an implant may be a good choice.  This is usually not the case.  However, if an implant is placed properly, it will not be noticeable.  - Best wishes

David Alessi, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 16 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.