Why Didn’t My Paranasal Augmentation Work?

Q: Dr. Eppley, I have some questions about paranasal augmentation. I have a rib graft used for a rhinoplasty to build up the bridge of my nose as well as placed around the base of my nostrils to give my nose more height and my mid face more projection. After six months I see little effect on reducing the depth of my nasolabial folds and not much midface projection. Why did this happen and what can I do to improve it further?
A: Let me explain to you the concept of paranasal augmentation and why you have the result that you do. Augmenting the pyriform aperture (nasal base or paranasal region) is designed to push out the base of the nose (provide some increase in midface projection) but will not have any significant effect on the the depth of the nasolabial fold unless a very large augmentation is done. The nasolabial fold is created by a soft tissue problem and thus to really be softened in its depth must be treated by a soft tissue approach like injectable fillers or fat injections which are placed directly under the skin not deep at the bone level. Thus building up the bridge of the nose and the nasal base will create greater nasal projection not lessen the depth of the nasolabial folds
If a large paranasal augmentation is done that encompasses the entire base of the nose up along the sides, then some lessening of the depth of the nasolabial may occur. This requires the use of a silicone paranasal implant which is available for that purpose. However, you were adamantly opposed to any synthetic materials so this is why rib cartilages grafts were used. Since rib grafts are much smaller than larger paranasal implants, their effects on nasolabial fold reduction and nasal base projection is going to be minimal. Thus your aesthetic result in this area is the direct result of the material used to do it. You do have a paranasal augmentation that was done with a natural material but the result reflects the limitation of that material choice.