Low radix and dorsal hump - will need a radix graft instead so it will look more balanced? (photos)

The normal anatomic position of the radix should be somewhere between your upper eyelid lash line and upper eyelid crease. The radix is the lowest point above the bridge of your nose on lateral view. Some ethnicities are known for classically low radix: hispanic noses, middle eastern noses, african americans. If you have a straight dorsum (no hump) a radix graft may be useful to help augment the nose and provide a little more character to your profile. In my opinion, when patients have a dorsal hump is more effective to remove the hump to provide a straight dorsum and not use a radix graft. A ski-slope result occurs if the dorsum is over-reduced. The art in rhinoplasty is knowing how much to remove and how much to leave back. Looking at your pictures, a small hump reduction would result in a straight dorsum. Your radix isn't quite that low so you should not need a radix graft.

In my practice as a board certified plastic surgeon, I aim to customize all of my surgeries to properly harmonize with my patients’ facial aesthetics. In your case, if you would prefer – as most patients do -- to have a straight bridge without any concavity (“ski slope”), I certainly can help you achieve this by filing the bump (I prefer not to overzealously break bones), so that the bony elements of your nose are in line with the cartilaginous elements. Just based on your photos, is doesn’t appear you are in need of a radix graft, but a physical exam and further review of your goals would be needed. I recommend that you consult in person with a board certified plastic surgeon to discuss your goals and expectations. Bring pictures with you to help communicate the aesthetic you desire, which will help ensure that you and your surgeon are on the same page.

Based on these photos, you seem to be excellent rhinoplasty candidate. In person consultation with a board certified plastic surgeon, expert in rhinoplasty, would give you opportunity to discuss plan of surgery and possible result. Most surgeons performing rhinoplasty will have available 3D simulation tool available in the office, which may give you an opportunity to participate in planning of your surgery and see anticipated result. Good luck.