A mask assembly (500,700,900) comprising: a mask seal (504,704,904) comprising lateral portions; a mask base (502,702,902) comprising a pair of wings that include upwardly projecting portions that provide reinforcement to the lateral portions of the mask seal (504,704,904); the mask seal (504,704,904) comprising an upper surface (516,730,930) configured to underlie the nose of a user and define a primary seal between the mask assembly and the face of the user, a first hollow paddle and a second hollow paddle that extend upwardly from the upper surface (516,730,930), are configured to extend upward along the lateral sides of the nose of the user to create a secondary seal with the face of the user, and are configured to extend along a surface of the face adjacent to the nose of the user, an upward directed nasal opening (530,724) positioned laterally between the first and second hollow paddles (512,514) and through the upper surface (516,730,930), a rearward directed oral opening (526,722), a support region located on a forward-facing surface of each of the first and second hollow paddles (512,514), and a ballooning or flexing region, the support region being more rigid than the ballooning or flexing region, the support region overlying the ballooning or flexing region and being configured to control a ballooning effect of the ballooning or flexing region; and a mask seal clip integrated into a single component with the mask seal (504,704,904) and configured to connect the mask seal (504,704,904) with the mask base (502,702,902). a mask seal (504,704,904) comprising lateral portions; a mask base (502,702,902) comprising a pair of wings that include upwardly projecting portions that provide reinforcement to the lateral portions of the mask seal (504,704,904); the mask seal (504,704,904) comprising an upper surface (516,730,930) configured to underlie the nose of a user and define a primary seal between the mask assembly and the face of the user, a first hollow paddle and a second hollow paddle that extend upwardly from the upper surface (516,730,930), are configured to extend upward along the lateral sides of the nose of the user to create a secondary seal with the face of the user, and are configured to extend along a surface of the face adjacent to the nose of the user, an upward directed nasal opening (530,724) positioned laterally between the first and second hollow paddles (512,514) and through the upper surface (516,730,930), a rearward directed oral opening (526,722), a support region located on a forward-facing surface of each of the first and second hollow paddles (512,514), and a ballooning or flexing region, the support region being more rigid than the ballooning or flexing region, the support region overlying the ballooning or flexing region and being configured to control a ballooning effect of the ballooning or flexing region; and an upper surface (516,730,930) configured to underlie the nose of a user and define a primary seal between the mask assembly and the face of the user, a first hollow paddle and a second hollow paddle that extend upwardly from the upper surface (516,730,930), are configured to extend upward along the lateral sides of the nose of the user to create a secondary seal with the face of the user, and are configured to extend along a surface of the face adjacent to the nose of the user, an upward directed nasal opening (530,724) positioned laterally between the first and second hollow paddles (512,514) and through the upper surface (516,730,930), a rearward directed oral opening (526,722), a support region located on a forward-facing surface of each of the first and second hollow paddles (512,514), and a ballooning or flexing region, the support region being more rigid than the ballooning or flexing region, the support region overlying the ballooning or flexing region and being configured to control a ballooning effect of the ballooning or flexing region; and a mask seal clip integrated into a single component with the mask seal (504,704,904) and configured to connect the mask seal (504,704,904) with the mask base (502,702,902).