The Peri-Pyriform Procedure
Paranasal Augmentation
Dr. Jonathan Zelken, MD · Board-Certified · Newport Beach, CA
For nearly a decade, Dr. Zelken has refined the lower midface — softening deep nasolabial folds and adding gentle profile projection with results that look entirely natural.
Approach
Dr. Zelken's Philosophy
Restoring the lower midface is one of Dr. Zelken's favorite operations. By softening or eliminating deep nasolabial folds and adding subtle projection to a flat midface on profile, he can refresh the center of the face without ever looking overdone.
For nearly ten years, Dr. Zelken has performed paranasal — or peri-pyriform — augmentation at the Zelken Institute for Aesthetic Medicine in Newport Beach, and he has authored scientific work on the subject. That blend of surgical precision and published expertise is rare for a procedure many surgeons never learn to perform.
His philosophy here mirrors his approach to every operation: enhance your natural architecture rather than change who you are. The goal is a balanced, harmonious profile that looks like you — simply more rested and refined.
The Procedure
What is Paranasal Augmentation?
Pyriform aperture augmentation — often called paranasal or peri-pyriform augmentation — builds up the lower midface around the base of the nose. It can soften deep nasolabial folds and add projection to a face that appears flat or concave in profile.
The procedure can be performed on its own or alongside rhinoplasty or a facelift, using your own tissue, filler, or a small implant. Because midfacial flatness isn't tied to age, it can benefit younger patients as well as those noticing age-related changes.
Even Queen Nefertiti, celebrated for her sublime jawline, shows the subtle midfacial flatness that paranasal augmentation is designed to address — a reminder that this is about proportion and profile, not simply aging.
Peri-pyriform / premaxillary implant shown in its intended anatomic position.
Tailored to You
Ways to Augment the Midface
Several paths to the same natural result.
- Filler & Fat Grafting The least invasive option, adding volume at the base of the nose. Effective and affordable, though generally more subtle and less permanent than a structural implant.
- Orthognathic Surgery A major operation that cuts and repositions the jaw bones. Reserved for significant underbite or malocclusion, and best avoided when a simpler approach will do.
- Autogenous Bone or Cartilage Uses your own tissue to augment bone with bone. Philosophically ideal, but cartilage can resorb and bone is unforgiving to sculpt, risking visible step-offs.
- Silicone Implants Dr. Zelken's preferred method. A soft, malleable implant is carved or placed through two small incisions above the canines, held by a precise pocket rather than screws.
- Porous Polyethylene & Gore-Tex Rigid Medpor is screwed into place; softer Gore-Tex (ePTFE) is sewn or pocketed. Both are effective alternatives Dr. Zelken selects when a case calls for them.
- Custom PEEK Implants For post-traumatic or congenital asymmetry, custom implants can be manufactured in-house from PEEK using a low-dose cone-beam CT scan for precise planning.
Benefits of Paranasal Augmentation
Softens or eliminates deep nasolabial (smile) folds.
Adds natural projection to a flat or concave midface.
Improves the profile and columellar-labial angle.
A permanent alternative to repeated filler treatments.
Pairs easily with rhinoplasty, facelift, or buccal fat removal.
Often completed in 30 minutes or less by an experienced surgeon.
Is It Right For You
Who is a Good Candidate?
You may be a good candidate if you're looking for a more lasting solution to deep laugh lines — the smile lines many people treat repeatedly with filler. Patients with true skeletal insufficiency in this region often share a few telltale features: an acute columellar-labial angle, reduced show of the upper teeth, flattening or concavity of the lower midface in profile, and a perceived or actual underbite.
Dr. Zelken sees the greatest change in patients with visible hollowness right beside the edge of the nostrils. Because this is a matter of proportion rather than age, it suits younger patients as well as those noticing age-related change. A desire for a more convex midface is especially common among patients of Asian and Black heritage.
As with any procedure, the right approach is confirmed during your consultation, where Dr. Zelken evaluates your anatomy and goals together.
What to Expect
The Procedure
Dr. Zelken favors a soft silicone implant, either carved from a silicone block or selected off the shelf. Working through two small incisions above the canines, he relies on a meticulously created pocket — rather than sutures or screws — to hold the implant in a stable position. In experienced hands, the procedure often takes thirty minutes or less.
Healing Timeline
Recovery
First Days
- Expect mild swelling and tenderness around the upper lip and cheeks. Because the incisions sit inside the mouth, there are no visible external scars.
First Weeks
- Most swelling settles over the first couple of weeks. Dr. Zelken's team provides detailed care instructions, including soft-food and oral-hygiene guidance, to support smooth healing.
Settling In
- As residual swelling resolves, the refined midface and softened folds become steadily more apparent, revealing a balanced, natural profile.
The Outcome
Results & Longevity
An implant offers a lasting result where filler and fat grafting are more temporary. The changes are measurable yet refined: in research Dr. Zelken co-authored, paranasal augmentation produced modest anatomical changes that meaningfully enhanced beauty and patient satisfaction — subtle by design.
That subtlety is the point. Rather than dramatically altering your face, the goal is a softer smile line and a more balanced profile that looks entirely natural. Most people notice you look refreshed without ever suspecting a procedure.
This mirrors Dr. Zelken's broader philosophy: enhance your existing features, preserve what makes you distinctive, and let the improvement speak quietly for itself.
Transparency
Risks & Considerations
As with any surgery, paranasal augmentation carries some risk — including implant migration, bone absorption, nasal bleeding, and infection. These risks fall significantly when your procedure is performed by a board-certified surgeon, and Dr. Zelken reviews every consideration openly during your consultation. Following your pre- and post-operative instructions closely further supports a safe recovery and lasting result.
Explore More
Related Procedures
Begin Your Journey
Ready to Refine Your Profile?
If paranasal augmentation is on your mind, contact us to schedule a consultation with Dr. Jonathan Zelken and discover how he can help you reach your goals.
Common Questions
Paranasal Augmentation FAQ
Common questions about paranasal augmentation with Dr. Zelken.
It builds up the lower midface to soften deep nasolabial folds and add gentle projection to a flat or concave profile.
Not quite. Filler and fat are temporary; a paranasal implant provides structural, lasting augmentation that filler alone cannot match.
Two small incisions are made inside the mouth, above the canine teeth, so there are no visible external scars.
In experienced hands, paranasal augmentation with an implant often takes thirty minutes or less to complete.
Yes. It's frequently performed alongside rhinoplasty, facelift, or buccal fat removal to enhance overall facial harmony.
Most patients do well with a carved or off-the-shelf silicone implant. Custom PEEK implants are reserved for complex or asymmetric anatomy.
Possible risks include implant migration, bone absorption, nasal bleeding, and infection — all reduced with a board-certified surgeon.
No. Because midfacial flatness isn't tied to age, the procedure suits younger patients and those noticing age-related change alike.