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Some Asian faces are well known to have a mid facial concavity or lack of forward facial projection. As a result augmentative rhinoplasty is one of the most common facial procedures performed in this ethnic group to increase the height and length of the nose. As part of the underlying facial deficiency and a procedure which can be combined with rhinoplasty is paranasal augmentation. As an adjunct to the rhinoplasty building out the base of the nose as its height and length is increased potentially improves the overall facial result. Studies evaluating the outcome from these combined mid facial procedures is limited.

In the April 2023 issue of the Annals Of Plastic Surgery Published Ahead of Print an article on this topic was published entitled ‘Application of Paranasal Augmentation Rhinoplasty in Asians With Midfacial Concavity’. Over a nine year period between 2010 to 2019 sixty-seven (67) patients who had rhinoplasty with simultaneous paranasal implant augmentation with ePTFE were reviewed.

The patient population was young as would be expected averaging 28 years of age. Patient satisfaction with the procedure was 90%.  Eight (8) patients in the study had complications which included 3 cases of infection and five cases of implant malposition/displacement which required revision, an overall 12% complication rate.

This paper supports that the combination of rhinoplasty and paranasal augmentation is synergistic. And in some patients both really need to be done from an aesthetic standpoint as each one alone can make the other look more deficient. Rhinoplasty alone may draw attention to the flat paranasal regions. Conversely paranasal augmentation alone can make the nose look even more flat. There are numerous methods for paranasal augmentation from fat injections, various types of bone grafts to implants. Implants offer volume and shape assurance but also run the risk of infection, asymmetry and malposition….which did occur in this clinical series and is not unexpected, regardless of the implant material used. A 10% implant complication rate is not unreasonable and fortunately revisional surgery was able to adequately address them.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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