Nuances of Profile Management- The Radix
Rhinoplasty: Case Example 3- Cartilage Grafts for Balanced Nasal Profile
Case Examples
Case 3
A 58-year-old female presented for primary rhinoplasty requesting a smaller nose. Nasal analysis revealed a caudally positioned and under-projected radix, over-projected rhinion and an over-projected tip (Fig. 9).
The entire bony nasal vault was under developed and overly narrow. The nasal tip was greatly over-projected and the nasal base excessively wide. This created a typical “bottom heavy nose”. The patient also exhibited loose redundant nasal skin. The excess nasal skin prevented aggressive reduction of nasal tip projection.
Because of these findings, it was elected to augment the width and height of the bony nasal vault and to perform a conservative retro displacement of the tip. The width of the nasal base was also reduced. The bony nasal vault was augmented in width and dorsal height by using a single large septal cartilage graft (See Figure 6).
One and a half years postoperative views reveal a lengthened and more ideal nasal profile (Fig. 9). Without the use of the large radix and bony dorsal graft, greater reduction of the cartilagenous dorsum would have been necessary. Consequently, the nasal tip would have required a comparatively greater degree of retro displacement. This in turn, would have resulted in an unnatural and unbalanced nasal profile.
Figure 9A: Necessary surgical steps to create a more balanced profile. Combination of wide nasal base and narrow under projected radix creates “bottom heavy nose”. The bony nasal vault was augmented in width and dorsal height using single large septal cartilage graft. Nasal base was narrowed 8mm. Projection of nasal tip and caudal nasal dorsum reduced.
Figures B-G: Preoperative and 1.5 years postoperative photographs.
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