Alar base Implant (prosthesis): how to avoid regret. Why positional displacement is prone to occur

Regret following alar base Implant (prosthesis) most often stems from positional displacement from the intended location (positional abnormality). In facial implants generally, positional displacement is reported as a more frequent complication than infection. Dedicated research examining this specific procedure is limited; we organize the rationale based on evidence from nearby anatomic sites and similar materials.

Dedicated research targeting this procedure is limited

Clinical studies focusing exclusively on Implant (prosthesis) insertion at the alar base are currently limited. Here, we organize the approach based on evidence concerning nearby sites and materials—such as silicone implants in the nasal dorsum or malar implants.

The most common complication in facial implants is positional displacement

Imaging studies of malar implants report that positional abnormality of the implant is the most frequent complication, with infection, abscess, and spread to surrounding tissues occurring at lower rates. Furthermore, among facial implants, malar implants rank in the higher-infection-rate category.[1] While not data directly applicable to alar base implants, this represents a common trend across facial implants generally and serves as a reference.

There are also concerns inherent to the silicone material itself

Reports spanning 30 years of silicone implant use on the dorsum of the nose have indicated that silicone implants carry a historically recognized high risk of infection and extrusion (implant pushing through the skin).[2]However, the same report argues that refinements in surgical technique can reduce these risks, suggesting that the care taken during placement, rather than the material itself, can influence outcomes.

The shape deformity of the alar base differs from person to person.

Alar base abnormalities are said to result from multiple overlapping causes: congenital conditions, trauma, infection, excessive removal during previous surgery, and the effects of techniques that excessively elevate the nasal tip.[3]When causes differ, the points to confirm before placing an implant (prosthesis) also change.

Misjudging the cause of asymmetry means an implant (prosthesis) alone may not correct it.

When there is a difference in the height of the alar base attachments on the left and right, this can signal a deficiency on the premaxilla side of the maxillary skeleton, and in such cases, adding cartilage beneath the alar base has been noted as a corresponding approach.[4][5]It is necessary to confirm in advance whether the cause of the asymmetry lies not only in the position of the implant (prosthesis) but also in skeletal structure.

If you have undergone surgery or implant placement previously, a more cautious approach is needed.

It has been noted that many patients requiring augmentation surgery already have a history of multiple prior surgeries and face depleted tissue stocks available for grafting due to complex deformities.[6]Patients who have already had an implant (prosthesis) placed in the nose often present with more complex deformities, and higher revision surgery risk has been reported.[7]Furthermore, treating the nasal base technique as a minor secondary element of nose surgery, or failing to adequately consider the anatomy specific to this region, has been identified as a cause of surgical error.[8].

Points to confirm during consultation

The first is whether the asymmetry is solely a matter of implant (prosthesis) position, or whether skeletal factors are also involved.[4][5]The second is whether you have had previous nose surgery or implant placement.[7]The third is how to manage the situation if positional displacement occurs.[1]Since the condition of the nasal base is determined by its relationship with adjacent structures, final judgment can only be made during actual examination.[9].