High Radix in Rhinoplasty

Q: Dr. Eppley, I am interested in the following surgeries:

1. High radix rhinoplasty

My nasal bridge/nose-raix is high and little bit wide. The nasal bridge/nose radix is shallow, without an indentation.

I want to make my nasal bridge narrow and located low as possible. I also would like my nasal bridge to have an indentation/a recess.

You wrote what can be done to make the high radix low – 

“Reduction of the high radix can usually not be done by rasping or shaving alone. This only gets the lower end of the radix and will not make a signficant difference. It requires an osteotome to reduce it after an initial osseocartilaginous reduction is done. This may need to be combined with a direct osteotomy done through a punch incision by a small osteotome through the nasal skin from above as well. Guarded rotary drills can also be used to burr the radix down.”

I accept this method of surgery and I want to undergo surgery.

You also wrote “Radix deformities exist in some classic nasal problems. A high radix is often seen in the very overprojecting nose with a large dorsal hump. The nasal and frontal bones are overdeveloped raising radix height with the rest of the dorsum”.

To this I have a question:

Are my frontal bones overly developed (and if so, is it possible to reduce my frontal bones in my case)?

I know that feminization facial surgery deals with the reduction of overdeveloped frontal and nasal bones, and you do facial feminization surgery so if it is possible in your hospital I want to undergo this type of surgery and reduce frontal bones if they are over-developed, and I want to make my nose radix low.

A: In answering your thoughtful questions about what can be done about the high radix in rhinoplasty, I have done some imaging looking at the combination of a combined rhinoplasty and brow bone-forehead reduction (shaving reduction) for the most change that is possible at the fronto-nasal junction. This is what is possible with a radix reduction combined with a frontal reduction as well.

Dr. Barry Eppley

Indianapolis, Indiana