Is radix augmentation necessary for dorsal hump removal if you have a low radix?

Hello, hope you are well. That is a great question! It really depends on the individual's nose and surgeon's experience. With a very deep and/or low radix, lowering the dorsum to match it's height can look excessive. I tend to prefer a mixed approach of lowering the dorsum to the desired height, and then using a radix graft if needed to smooth out the appearance of any residual hump. This is a situation where a little morphing exercise can be very beneficial in visualizing the difference in these approaches.
Best,Dr. Tower

Hello from Istanbul! Your concern is understandable and actually quite common. Augmenting the radix isn't strictly necessary for everyone, but it does offer several advantages when removing a dorsal hump, particularly if you have a low radix to begin with. Carefully augmenting it in harmony with the position of the crease of the eyelid creates a more balanced nose bridge. It also helps redrape the excess skin when the hump is removed. A skilled surgeon can perform this augmentation without resulting in an exaggerated or "avatar-like" appearance. I would certainly recommend considering radix augmentation for optimal results. Hope this helps, best of luck!

A photo will be very helpful, but, overall there may be a way to lower the nasal dorsum without enhancing the radix. Pictures are key.

I haven't augmented a radix in a looong time. I agree. Even if it doesn't give an Avatar look or a Roman statue look, it makes the nose look longer, because the top of the nose is now not at the bottom of the radix, but at the lower part of the eyebrows, if that makes sense to you. Also, When the bump is lowered, the deep radix tends to look less deep. And as you point out, it is a feminizing look.


It's possible to get this all figured out with morphs before surgery -- lower the bump, make other changes like raising the tip and deprojecting the nose if necessary, and *see* whether you think it looks natural. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The operation requires techniques and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

I don’t care for radix grafts at all. They often don’t blend in very well. Often they are visible or just look weird

In our practice, the far majority of people do not need radix augmentation. We rarely use this grafting technique as long as the radix is in an acceptable position. Digital computer imaging of your nose upon your facial features would be helpful to understand what can be accomplished with a closed rhinoplasty

Radix augmentation is decided depending on the nasofrontal angle value that will occur after dorsal hump resection. Whether it will be done or not can be determined by the physical examination performed before the surgery. A diced or crushed cartilage graft can be used.

Low radix and dorsal hump: you don’t show a picture so I will have to address you a question in generalities. It is not necessary in my opinion, to augment the radix in order to reduce a dorsal hump in someone with a low radix. You don’t indicate whether you are male or female but a high radix in a female is particularly unattractive. A low radix in a female unless it is particularly unusual is not unappealing. Radix augmentation has its own drawbacks including movement or shifting of the implant and the implant becoming visible as swelling goes down. Radix augmentation may be more indicated in some ethnic noses where there is virtually no radix. But otherwise, the vast majority of people who simply have a low but not unusual radix would do fine to have the dorsal homes removed without augmenting the radix.