Premaxillary Deficiency: Techniques in Augmentation and Reconstruction

Abstract

Progressive premaxillary retrusion is a common sequela of the facial aging process. In most cases, this manifests with central maxillary recession. Central maxillary insufficiency is also commonly encountered within certain ethnic communities, or in cleft lip nasal deformity, and may represent a challenge for the plastic and reconstructive surgeon attempting correction in the setting of facial contouring, rhinoplasty, or reconstruction following oncologic resection or trauma. Aesthetically, premaxillary retrusion may be coincident with an acute nasolabial angle and ptotic nasal tip. Minor deformities may be addressed with use of either alloplastic implants, autogenous tissue, lipotransfer, or injectable filler. Larger composite defects may require reconstruction with implementation of free tissue transfer. Herein, we describe techniques that aim to augment, or reconstruct, the premaxillary region in the context of nasal deformity, osseous resorption, or composite maxillofacial defects.

Introducing an esthetic treatment of malocclusion: Ultrasound‐assisted augmentation of premaxilla with injectable hyaluronic acid filler

“…16 Premaxillary region is the bony part located between two maxillary osseous fissures. 10 Structural deficiency in this region is usually characterized by lack of maxillary projection, malocclusion, and nasal tip ptosis. 10 The main and absolute treatment of Class The transducer was in non-contact mode, located perpendicular to the skin surface and the patient was in 45 degrees semi-sitting position.…”

“…Class III malocclusion is usually perceived to be due to mandible overgrowth or its extra projection, but the structural cause is usually a combination of maxillary retrusion and mandibular protrusion and/or overgrowth 16 . Premaxillary region is the bony part located between two maxillary osseous fissures 10 . Structural deficiency in this region is usually characterized by lack of maxillary projection, malocclusion, and nasal tip ptosis 10 .…”

“…This augmentation is usually done by using an implant or graft during surgeries. 10 The second step was augmentation of the deep pyriform spaces. Based on assessment of the exact depth of the deep pyriform spaces and investigating the vascular pattern by using ultrasound in both sides, we selected the appropriate device needed for filler injection at each side (Figure 2).…”

Lip enhancement and mouth corner lift with fillers and botulinum toxin A

“…In other cases, a combined approach or surgery may be more appropriate to obtain best possible results. 9,10 The shape of the lips is not uniform. Lip shapes can be classified…”

“…Fillers can be helpful in restoration a youthful and natural appearance of the lips and the perioral tissue. In other cases, a combined approach or surgery may be more appropriate to obtain best possible results 9,10 …”