Who is a good candidate for alar base Implant (prosthesis)? It depends on whether the depression is caused by bone structure or skin sagging.

Alar base Implant (prosthesis) works best for people whose lower nose and upper lip area appears depressed due to a low bony foundation. If nasolabial folds are caused by sagging skin, advancing the Implant (prosthesis) forward will not lift the area, so you may not achieve the desired result. For those considering surgery to heighten the nose, whether to correct this depression at the same time will change the overall impression of the result.

What kind of depression is suitable for Implant (prosthesis)?

Depression caused by a low bony foundation. In Asians, the anterior maxilla is often underdeveloped, and a low nose frequently accompanies depression at the alar base.[1]The impact of this depression on overall facial balance is easily overlooked.[1][2]

Asymmetry can also provide clues. When only one side has a high alar base with a longer distance to the lip, it may indicate insufficient bony foundation on that side.[3][2]

Does this work for people concerned about nasolabial folds?

It depends on the cause of the nasolabial folds. An implant placed in the center of the face advances tissue forward but does not lift it.[4]Although nasolabial folds and under-eye depression may improve, textbooks note this is not a reliably expected result.[4][2]

If cheek sagging is the reason for deep nasolabial folds, Implant (prosthesis) alone may feel insufficient. It is important to have a professional assess whether depression or sagging is the primary cause.

Should this be considered together with nose-heightening surgery?

For those with depression, it is worth considering together. It has been reported that in Asians with central facial depression, surgery alone to lengthen and heighten the nose is unlikely to produce satisfactory results and is associated with more complications.[5]Adding a procedure to elevate the alar base to nose surgery is reported to improve results and satisfaction.[5][2]

In a study comparing 56 people with low nose and alar base depression, the group that had alar base elevation showed better improvement in the projection of the alar base.[1][2]

Implant (prosthesis) versus cartilage—what differs by choice?

Both have points to watch. Materials for elevating the alar base include both artificial materials such as silicone and your own tissue such as rib cartilage.[5][2]

In a study of 68 people using finely minced rib cartilage, over a median follow-up of 6.5 months, cartilage displacement was observed in 19.1% and partial absorption in 2.9%.[5]Artificial materials used in the nose have been reported to cause infection, extrusion, displacement, irregularity, and prolonged swelling.[6][2]

With artificial materials, the earlier problems are detected and managed, the smaller the deformity can be kept.[6]When choosing a material, it is reassuring to ask about the response plan if issues arise.

Things to confirm before the procedure

There are three benchmarks for judgment. The first is whether the depression is due to the bone foundation or skin sagging (skin laxity).[1][4]The second is whether it will be done together with nose surgery.[5]The third is preparedness for displacement or infection with each material.[5][6][2]

The depth and left-right asymmetry of the alar base depression can be difficult to see by mirror alone. Ask your doctor to examine your profile and bone foundation during the consultation to confirm whether an Implant (prosthesis) fits your depression.