Is a radix graft a good idea?

Question

I've been told that my deep radix makes my tip appear larger than it really is and that raising it would make tip narrowing more successful? Does this make sense? Do you think a radix graft is too risky or is it generally successful? Would this be common in rhinoplasty? I'm afraid that it will make my nose look bigger, which is not what I need at all. I'm also afraid that it won't look symmetrical... I need a quick answer, /please/!!

Ronald J. Edelson, MD · Answer

I have never used a radix graft nor thought it was necessary.  Radix grafts can shift or show through the skin after the swelling goes down.  Best to keep it simple and only use a radix graft when absolutely necessary.  It doesn't sound like it is needed in your case.

Gerald Minniti, MD, FACS · Answer

Hello,Radix grafts are on-lay type grafts that need to be carefully placed and secured, usually with a transdermal stitch that is removed a few days after surgery.. This is not a problem for expert rhinoplasty surgeons however, and they can be an excellent and reliable tool to help improve the nasal appearance. These grafts serve to lengthen nose, not narrow the tip. Best of luck!

Toby Mayer, MD · Answer

Radix graft is a good idea for patients who need this. A low radix makes the lower third of the nose look larger as described by Leonardo da Vinci.therefore it actually makes the nose appear smaller. See a very experienced rhinoplasty surgeon Who is familiar with this technique for the best results. Look at before and after pictures of the surgeons work.

Paul E. Chasan, MD, FACS · Answer

Whether you need a radix graft really depends on your anatomy and the judgment of your surgeon. I commonly use radix grafts when needed, however many times after I bring down the dorsum, there is no need for a radix graft. This is a good place to use computer imaging to see what it would look like both ways.

William Portuese, MD · Answer

A radix graft is only used when patients have a low radix and order build up that area. Without a set of pictures, its impossible to give any determination about what may or may not be required.

Robert Kotler, MD, FACS · Answer

Dear Glendale Friend:

If the deep Radix makes the bridge of your nose so low
that in contrast the tip seems larger, then it may make sense to raise it.  Yes, there are options.  One includes the grafting of cartilage.  The other is implantation, surgically, of a
silicone or plastic part or implant.  The
third is to use a filler, either temporary or permanent.  None of these are considered risky.  They are all common.  The result would not necessarily make your
nose look larger because, apparently, that part of your nose is deficient and,
therefore, needs to be made larger so there is a better “match” with the lower
part of your nose.

The most important thing you can do is have consultations
with rhinoplasty surgeons who major in that procedure.  This would be somebody who does nearly
exclusively cosmetic nasal surgery of the nose to the exclusion of emergency
room, auto accident, cancer work, and reconstructive surgery.  When you go for consultation you want to have
computer imaging so you can see the surgeon’s vision for the outcome.  That will help you understand whether or not
you would be happy with the outcome. 
Bring a friend or family member with you because there is a lot to
learn.  Before you go for consultation,
study many doctors’ websites, look at their reviews, their before and after
photographs, and study their resume.  Generally,
more experience and more specialization is better than less.

Consider a Skype consultation to get a sense of the
doctor’s view of what may be accomplished. 
Best wishes,

Robert
Kotler, MD, FACS

Over
4,500 nasal procedures performed

Barry L. Eppley, MD, DMD · Answer

A radix graft is not really going to change the appearance of the nasal tip. A radix graft is for helping the appearance of the dorsal line and making the transition of the forehead into the nose slightly improved.

Aaron Stone, MD · Answer

I have put a few of these in patients and don't recall them making much of a difference on the appearance of the tip. It is not a risky procedure when performed by the right surgeon on the right patient. It is not that common a procedure but it is not rare. More patients get grafts along the entire bridge than just the radix. If your tip is large you need work on the tip cartilages not a radix graft. My use of them has been mostly to reduce epicanthal folds because I would rather put an implant in through an internal incision than cut the fold and leave the patient with an external scar.Without a posted photo it is impossible to tell if a radix graft would be appropriate for you. On a side view the radix to convex tip of the cornea should be 10 to 12mm in the absence of any eye pathology. If your measurement is 2 to 5mm in the absence of eye pathology a 5 to 7mm thick implant should suffice.I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship in order to know if this assessment is valid.

Douglas J. Mackenzie, MD · Answer

A radix graft is a straightforward surgical maneuver for any competent rhinoplasty surgeon.  However, how it might look on YOU is an easy thing to check if the surgeon uses computer morphing software.  This by far is the best way to simulate how rhinoplasty will change YOUR nose.  It is very important tool that I use to educate my rhinoplasty patients, and to make sure that my patient and I are "on the same page" going into surgery.  In this computer age, it is unfathomable why any rhinoplasty surgeon would not have this technology available for his/her rhinoplasty patients.

Robert Singer, MD · Answer

Radix grafts are routinely performed in the appropriate patient to achieve a natural  harmonious nasal appearance.
Keep in mind that following advice from a
surgeon on this or any other website who proposes to tell you exactly what to
without seeing photos and more importantly without examining you, physically feeling
your tissue, assessing your desired outcome, taking a full medical history and
discussing the pros and cons of the operative procedure would not be in your
best interest. Natural appearing results need to be individualized and what is appropriate
for one patient is not necessarily the best for someone else. I would suggest
that you find a surgeon with extensive rhinoplasty experience certified by the
American Board of Plastic Surgery and one who is ideally a member of The
American Society for Aesthetic Plastic Surgery (ASAPS) or a facial plastic
surgeon (otolaryngologist) that you trust and are comfortable with. You should
discuss your concerns with that surgeon in person.
Additional information about the procedure will
help you decide if it is a procedure that you want to pursue.
Robert Singer, MD FACS
La Jolla,California

Is a radix graft a good idea?

Answers (13)

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