One of the most aesthetic augmentations in the face due to a natural genetic shape is the midface in Asians. Lack of forward development of the nasal base (pyriform aperture) is common in such patients, and while paranasal augmentation was once reserved for an adjunctive procedure in rhinoplasty, it is now often done as a stand alone aesthetic procedure.
Paranasal augmentation can be by a variety of graft and implant techniques, each with their own advantages and disadvantages. An implant offers a stable augmentation effect and avoids a graft harvest. A variety of paranasal implant designs are available off-the-shelf in different materials with variations in its shape. Custom paranasal implants are also available using the patient’s 3D CT scan.
In the May 2024 issue of the Aesthetic Plastic Surgery journal an article was published on this topic entitled ‘Morphological Measurement of Asian Osteal Nasal Base for Paranasal Augmentation.’ In this study the authors evaluated 3D face CT scans and measured the bony shape of the paranasal region in fifty-seven (57) young Asian patients. The lower pyriform aperture region was divided into an alveolar, paranasal and maxillary triangular regions of which the angles between them could be measured. The degree of paranasal deficiency/concavity was also graded for severity by a single surgeon and compared to the measured zones.
For design of paranasal implants, the lengths of both lower and lateral edge were measured for reference. In a regression analysis, the alar base-alveolar process angle was significantly associated with the degree of paranasal concavity.
In many paranasal deficiencies there is a difference between the projection of the alveolar process inferiorly and the side of the nose superiorly. This angular difference is what defines a paranasal deficiency when a Class III or edge to edge occlusion is not present. An implant design may need to consider providing augmentation of the nasal base out onto the maxilla. Whether this should be done by a standard or custom paranasal implant design can be debated.
Dr. Barry Eppley
World-Renowned Plastic Surgeon