Intranasal surgical approach for malar alloplastic augmentation.

BACKGROUND: Alloplastic malar augmentation is becoming an increasingly common procedure for enhancement of the midface and an adjunct method of improving the effects of other rejuvenation procedures.

OBJECTIVES: The authors present a new surgical approach for placement of malar implants by means of an intranasal incision, which they believe has several advantages over traditional techniques. They also propose a new classification for regions of the midface to assist in augmentation planning.

METHODS: Between 1990 and 2010, the authors treated 20 patients with an intranasal approach for alloplastic malar augmentation. Patients were preoperatively divided into three groups: Type 1 included those with adequate nostril opening, including good elasticity of the internal nasal mucosa, allowing a good exposure of the piriform aperture through the nasal speculum; Type 2a included those with inadequate nostril opening; and Type 2b included those who required an alar base correction. Implants were selected according to these classifications and placed with the authors' technique.

RESULTS: Of the 20 patients treated, 18 were female and two were male. Ages ranged from 15 to 65 years. Average follow-up was 10 years, and all patients experienced favorable results. There were no major complications, no nerve or vascular supply compromise, and no cases of implant malposition. One patient requested removal of the implant at one year postoperatively despite her good postoperative outcome; overall patient satisfaction was 95%.

CONCLUSIONS: The intranasal approach for alloplastic malar augmentation has shown good results for midface enhancement in the authors' hands. In this patient series, results showed excellent overall patient satisfaction and a very low (nearly 0%) complication rate.