Hello bellelewis1 - Thanks for your question. Paranasal augmentation involves placing graft material on either side of the nostril in the pyriform space to soften the medial nasolabial folds when there is significant bone loss in that area. In my practice, I use Radiesse (filler), fat (filler), Medpor implants, or stacked cartilage grafts. Of course, you could perform certain types of bone cuts (Le fort osteotomies) to move the bone forward, but this is fairly aggressive and not typical in a cosmetic surgery case. Oral-maxillo-facial surgeons use this bone cutting more regularly as part of their dental surgeries to restore bite. I hope this helps?Dr. Shah