Dr. Sam Lam Plastic Surgery Forum

Hello,

I have a weird depression around the base of my nose (it's not really the nasolabial fold...more like the top of the nlf adjacent to the nostrils); I guess this would be called the "paranasal" region. I also recently watched your video on hard vs. soft fillers--what a great source of information you are! In your opinion, what kind of filler would be best to fill in this depression? (I know in Korea a lot of doctors use fat to fill in the paranasal area;what do you think about this?) Thanks so much in advance!

yes, this area is known as the precanine fossa or canine fossa. it is a triangular fossa that extends from the nose to the nasolabial groove. i almost always fill fat into this area as part of a fat transfer case but it is not to eliminate the fold but to improve just blending from the cheek down. if you want it filled, don't use fat. it is unreliable in this area. i prefer perlane because it is thick. but you will feel it possibly when you smile. i don't like solid implants because they can create truly a weird effect when smiling. i used to have this problem when working with extended premaxillary grafts that went all the way to the canine fossa. unfortunately, there is no magic bullet. however, i do believe we really focus too much on things that don't deserve our attention.
best,
sml

Thanks so much Dr. Lam!! I agree with your assessment--paranasal implants really do look odd when smiling. I've gotten Juvederm in this area before, and even that showed up in little ridges....ah well

On a somewhat related topic, have you ever considered / do you ever fat graft along the sides of the nose? I lost quite a bit of fat from my central face after an IPL procedure, and one of the most dramatic changes I've noticed is that my nose now appears much larger. After looking at some before and after photos, I've realized that losing the fat running vertically along the sides of my nose contributed very much to this final appearance. I wonder if fat grafting to this area would look odd? It's funny because I'm sure there wasn't a lot of fat there to begin with..but boy does even a little bit make a huge difference!

Thanks again Dr. Lam, and hope your weekend went well! (Forgot to mention...I've tried juvederm along the sides of my nose, and this DID NOT work because the texture was too firm and just made my nose look even wider. NOT good!!! )

ANSWERS IN ALL CAPS BELOW:
Thanks so much Dr. Lam!! I agree with your assessment--paranasal implants really do look odd when smiling. I've gotten Juvederm in this area before, and even that showed up in little ridges....ah well
THAT IS MOST LIKELY TECHNIQUE. TYPICALLY YOU SHOULD NOT SEE RIDGES. RIDGES APPEAR WHEN THE PRODUCT IS PLACED INTRADERMALLY. IT IS USUALLY BETTER TO PLACE IT DEEPER.

On a somewhat related topic, have you ever considered / do you ever fat graft along the sides of the nose? AS I SAID, ALL THE TIME BUT IT IS UNRELIABLE TO FILL THE QUALITY OF THE FOLD, I.E., TO REDUCE THE NATURE OF THE FOLD. THEREFORE, I WOULD NEVER DO IT AS A STANDALONE PROCEDURE BECAUSE IT IS UNRELIABLE. I KNOW THAT OTHER DOCS DISAGREE BUT I DON'T THINK THEY ARE GETTING RELIABLE RESULTS THERE. I lost quite a bit of fat from my central face after an IPL procedure, and one of the most dramatic changes I've noticed is that my nose now appears much larger. THAT IS TYPICALLY DUE TO GLOBAL LOSS. GO TO YOUTUBE AND TYPE IN "NOSE FACE AGING". THE FIRST VIDEO IS MINE. WATCH IT. After looking at some before and after photos, I've realized that losing the fat running vertically along the sides of my nose contributed very much to this final appearance. I wonder if fat grafting to this area would look odd? AS SAID IT IS UNRELIABLE. ALSO IF IT IS NOT BLENDED INTO THE REST OF THE FACE, THERE IS A POTENTIAL FOR IT TO LOOK ODD. It's funny because I'm sure there wasn't a lot of fat there to begin with..but boy does even a little bit make a huge difference!

Thanks again Dr. Lam, and hope your weekend went well! (Forgot to mention...I've tried juvederm along the sides of my nose, and this DID NOT work because the texture was too firm and just made my nose look even wider. NOT good!!! ) I REALLY THINK THAT IS TECHNIQUE DEPENDENT. ALSO YOU MIGHT BE MISSING FAT ELSEWHERE AND FORCING YOUR EYE TO ONLY SEE ONE PART OF THE FACE WHERE YOU THINK FAT LOSS IS OPTIMAL BUT IT MIGHT NOT BE THE CASE IN THAT ONE AREA, I.E., OTHER AREAS COULD BE WORSE.