Q: Dr. Eppley, I am interested in a rhinoplasty that changes the upper part of my nose. The lower half of my nose is fine but I have a large nasal hump and would like to get it reduced. In playing with some online imaging programs, I have noticed that removing the nasal hump actually looks worse in my opinion of the nasal radix is not also reduced. If the radix is not reduced it makes my nose and forehead appear as one with a sloped straight line, making more forehead looking like ‘volvo windshield’ in a profile view. If I am not given more of an obvious nasofrontal angle, my forehead will look weak Getting a good nasofrontal angle is the most important point of a rhinoplasty to me. How can this be effectively be done?
A: One of the more obscure aspects of rhinoplasty surgery is radix reduction. Radix augmentation is more common in many hump reductions. But in very large hump reduction in which the nasal bones are high and extend into the glabellar region of the forehead, radix reduction may be needed. In looking at your pictures your assessment is correct, a break between the forehead and your nose is needed to avoid a complete connected slope effect of the forehead down through the nose. Significant radix reduction as part of a rhinoplasty can be done by one of two methods; a guarded rotary burr or a percutaneous osteotomy method. Having done both, I find the osteotome method to work well when a really deep notching of the frontonasal angle needs to be done. This is done by using a 2mm osteotomy placed through the skin at the bridge of the nose creating one bone cut into the frontnasal angle, The other osteotome cut is done from inside the nose to complete the 90 degree angle creation.
Dr. Barry Eppley