Does alar base Implant (prosthesis) work? The magnitude of change shown by research and remaining uncertainties

Alar base Implant (prosthesis) (surgery to fill the bone depression at the base of the small nose) has been reported in case-based research to have the effect of filling mid-face depressions, but high-quality comparative studies between methods are still limited, and uncertainties remain regarding the magnitude of effect and frequency of complications[1][2]. In Asian nose surgery, because elevating the nose alone does not resolve mid-face depressions and complications are frequent, it has been performed as an addition to nose surgery[1].

What changes? Changes measured in research

Changes can be confirmed numerically when measured from a lateral view. In a retrospective study comparing 56 patients with low noses and lateral nasal depressions who were divided into a group receiving lateral nasal augmentation and a group not receiving it, the nasal columella base prominence and alar base prominence both improved in both groups, with the augmented group exceeding by 2.5 degrees at the alar base.[2]Satisfaction was assessed using FACE-Q, a patient questionnaire, and improvement evaluation by independent physicians.[2]However, this study used a method of inserting finely minced autologous rib cartilage through a tunnel-like pathway, not Implant (prosthesis).[2].

In Implant (prosthesis) reports, 67 patients (mean age 28.7 years) who underwent lateral nasal augmentation simultaneously with nose surgery for mid-face depressions from 2010 to 2019 were examined retrospectively, with satisfaction assessed by independent medical staff viewing pre- and post-operative photographs.[1]The authors noted that while this method can improve results and satisfaction, research focusing on technical details and evaluation is limited.[1].

What is the quality of evidence?

All existing research is retrospective, examining past cases.[1][2]There are no randomized controlled trials, and there is no data comparing Implant (prosthesis), autologous cartilage, and fat injection under the same conditions.[1][2].

A systematic review examining facial implants in general collected 13 studies with 620 patients, of which 69% were for aesthetic purposes, 46% were mandibular, 23% were nasal, 31% were porous polyethylene, 23% were silicone, and 23% were PEEK.[3]. While noting that measurement methods varied across studies making comparison difficult, it summarized that infection and nerve-related complications were reported.[3]In a study of 10 lateral nasal augmentations included in this review, compared to a control group with malar reduction, the post-operative alar width, alar base width, and nasolabial angle were significantly increased.[3]When filling depressions, the small nose may appear slightly wider.

What differs by material? Silicone, polyethylene, autologous cartilage

Numbers by material can only be read indirectly from nasal dorsum surgery data. In a meta-analysis of 53 studies, autologous rib cartilage had a higher complication rate of 14% overall because it is frequently used in revision surgery, while porous polyethylene (Medpor) had fewer complications but extremely difficult secondary surgery when problems occur.[4]. Aesthetic success rates ranged from 86% for silicone to 97% for Medpor.[4].

Textbook perspectives also vary. In Asians, thick nasal skin is associated with fewer implant-related adverse events, and all of silicone, ePTFE, and Medpor are noted to provide long-term satisfaction in most patients.[5][6]. However, regarding Medpor, the drawbacks of being a foreign material and increased risk of framework exposure are noted, and some authors do not recommend it, citing frequent revision surgery on the nasal septum and mobile nasal tip.[5][7]. A textbook method also describes finely mincing autologous cartilage and inserting 1.5cc on each side beside the piriform aperture (bone edge of nostril) to correct lateral nasal depressions.[8].

How common are complications? What is known and unknown

Infection rate, exposure rate, and displacement frequency specific to lateral nasal Implant (prosthesis) did not appear in the studies we collected.[1][3]For facial implants in general, infection and nerve-related complications are reported, so it is worthwhile to ask the facility about management if numbness occurs.[3].

There are reports providing thickness reference points. In a revision of 9 patients with nostril narrowing from over-removal of the ala, a study using porous polyethylene lateral nasal implants at an average thickness of 5.5mm (4.0mm to 7.0mm) combined with composite skin and cartilage grafts showed that 18 grafts had full or partial take with no failures.[9]. Since this is a revision surgery report, read it separately from first-time aesthetic numbers.[9].

Who is it suitable for? Setting expectations

It is suitable for patients with clear mid-face depressions that cannot be resolved by nose elevation alone.[1][2]Weak development of the anterior maxilla is common in Asians, and research notes that when low nose and depressions coexist, the impact on overall facial harmony tends to be underestimated.[2]In patients with mild depressions or those wanting to avoid the appearance of alar widening, the decision involves weighing the benefit of filling depressions against the possibility of alar widening.[3].

What to confirm at consultation

First is the degree of depression and whether the cause is bone or soft tissue.[2]Second is the choice of material and its reasoning, and the ease of removal if problems occur.[4][7]Third is the thickness and position of insertion.[9]Fourth is how the alar width and nasolabial angle will change.[3]Fifth is management if infection, exposure, or numbness occurs.[3][4].

The design varies with depression depth, skin thickness, maxillary shape, and concurrent nose surgery. Therefore, based on the article alone, you cannot determine which material and thickness are suitable for you. At consultation, have the degree of depression on lateral view, position of the alar base, and skin thickness confirmed, and work together to organize which material to insert and how much.