The radix graft in cosmetic rhinoplasty

Experience with rhinoplasty over time has shown that a detailed anatomic analysis of the nose is an essential first step in achieving a successful outcome. Failure to recognize a particular anatomic point preoperatively will often lead to a less than ideal long-term result. Deficiency in the radix is a commonly overlooked abnormality that may be found both in patients undergoing primary rhinoplasty and patients undergoing revision rhinoplasty after an overzealous bony hump removal. Whereas surgeons previously reduced the nasal dorsum down to the level of the radix on a routine basis, recent emphasis on a strong natural profile has focused attention on anatomic deficiency in the radix region. We describe a simple technique for treatment of the deep nasofrontal angle and present patient examples. Autologous cartilage grafts may be fashioned into a "radix graft" and reliably used to augment the region either with a precise pocket approach or without when a precise pocket is not possible, achieving a natural aesthetic result.