Background: Rhinoplasty involves potential manipulation of all components of the nose. One of the most common areas of change is of the hump or bump on the nose. While frequently though of as just, the nasal hump is actually a combination of bone and cartilage and the highest peak of the hump often represents where the two meet. The larger the nasal hump is, the more significant the bony part of it is.
The goal of nasal hump reduction is to establish a straighter dorsal line and create a more harmonious balance between the upper and lower parts of the nose. In establishing a lower and straighter dorsal line, the location of the radix is important. The radix defines the root of the nose where it takes off from the glabella. It occupies the portion of the upper nose from the glabella down to the level of inner/outer canthi. The radix is defined by its height and vertical position. As a general rule, the radix should lie between 10mm to 15mm in front of the cornea.
The position of the radix can have a great impact on how the nose looks. What it affects most is the appearance of nasal length. Since the radix marks the beginning of the upper dorsum of the nose, it directly influences nasal length. A high radix creates the impression of greater nasal length. A low radix decreases nasal length and makes the nose look shorter.
In large nasal humps, the nose appears quite top-heavy. The radix is way overprojected and the nasofrontal angle is wide open. The bone of the upper nose (bony vault) is overgrown. This draws the eye to the nasal bridge and make the nose look big.
Case Study: This 35 year-old male wanted a rhinoplasty to make his nose look smaller. He had a fairly straight nose but with a very large dorsal hump and a high nasion. The radix was almost at the level of the lower end of the eyebrow.
Under general anesthesia, he had an open rhinoplasty. The dorsal septum was reduced and a large nasal hump taken down with an osteotome. In removing the bone hump, a low path was taken which was then fractured off by a small osteotome making a perpendicular cut through the nasal skin at the nasion level. Rasps were then used to smooth out the bone edges and low lateral osteotomies were done to close the open roof. Some tip modification and shortening was done as well.
His nasal splint was removed one week later. By three months after surgery, the final shape of the nasal bridge and dorsal profile were seen. Besides a straight dorsal line, the position of the radix has been lowered as well.
The radix of the nose can have a significant effect on nasal appearance. It must be lowered significantly in the overprojecting nose so that the bridge of the nose blends into the rest of the nasal profile rather than being the dominant nasal feature.
1) Noses with large dorsal humps often have a high radix or protruding nasofrontal junction.
2) Large nasal hump reductions in rhinoplasties may require a percutaneous osteotomy technique to adequately reduce a high radix.
3) An appropriately placed radix enhances the effects of a straight dorsal line for a more pleasing rhinoplasty result.
Dr. Barry Eppley