honestly, the trick is not to augment the entire pre maxilla but just the nasal base. i don't use blocks of materials anymore in the premax because it causes too much discomfort when smiling. as mention in the thread, i use one's own cartilage only either as a morselized graft in the premax or as a tip graft/extension graft. although the results may be more subtle, it is much more natural looking and feeling.
best,
sml
