Nasofrontal or Radix Augmentation
One of the most vital facets for overall balanced aesthetics of the face is nasal length. A nose that appears to be too long or short will alter the observer’s perceptions of facial proportions, especially when observing the face in profile. The “root” of the problem often lies in literally the “root” of the nose, clinically known as the “radix”. When the angle from the radix to the tip of the nose is too sharp, too shallow or has bumps and other discontinuities, these issues can throw off the entire appearance of the nasal structure and thereby, facial symmetry and harmony.
Anatomy of the Radix
The radix is defined as the point of the nose where the nasal bones meet the frontal bone. Anatomically, the boundaries of the radix lie directly between the eye socket openings in the skull. While the rest of the nose protrudes from the base of the skull, the radix forms an indentation between the eyes. The foundation of the radix, called the “anterior nasal spine”, is made up of a thin line of bone. This bone structure secures the cartilage that comprises the upper portion of the nose.
Nasofrontal Angle in Ethnic Patients
The “nasofrontal angle” is an important measurement that cosmetic surgeons use to determine facial proportions. Dr. Slupchynskyj measures the angle that the bridge of the nose protrudes from the face, where the radix is the vertex of the angle. Some patients of ethnic descent tend to have a low and flat bridge and on occasion, a depressed radix or nasofrontal angle. In this case, the bone elevates from the radix and up towards the caudal point which is a low starting point and very high finishing point. Patients prefer to have it more balanced where the radix, or starting point near the eyes is not so low. In these cases where the nasofrontal angle is too low or shallow, the nose looks flat and blunted against the face. The angle can also have discontinuities in the form of bumps along the nasal bridge.
Nasofrontal Augmentation in Rhinoplasty
The procedure Dr. Slupchynskyj uses to correct problems with the nasofrontal angle is known as “nasofrontal augmentation”. Surgeon choice is critical in this case. Some surgeons will opt to remove the nasal bone in order to bring down the nasal bridge and meet radix height, (i.e. the lowest starting point of the nose). The proper treatment is radix augmentation where a customized implant is placed on the radix portion of the nose (see actual patient photos of Dr. Slupchynskyj below) and augmentation is achieved by elevating the radix to the height of the nasal bone, versus removing or drastically reducing the patient’s nasal bone. In Revision Rhinoplasty cases where the patient had too much nasal bone removed, augmentation is necessary. The goal is to provide a smooth line along the bridge and present a visually appealing profile.
The augmentation procedure involves the reshaping of the nasal cartilage and the inclusion of implants. Implant materials include alloplastic custom carved silicone implants, septal and auricular cartilage grafts, temporal fascia and rib cartilage grafts and Gore-tex. Salient points of a proper and successful radix augmentation include: 1) proper dissection of the implant pocket, 2) creation of an implant which is the exact size and shape required for each patient, i.e. customized implant and, 3) properly securing the graft or implant in place so it is fixated allowing no movement.
Nasofrontal augmentation is one of the more significant reasons that patients seek out Revision Rhinoplasty with Dr. Slupchynskyj. When another surgeon removes too much tissue during a Primary Rhinoplasty, or when the results of a Primary Rhinoplasty leave bumps and other irregularities on the nasal bridge, the patient often needs Revision Rhinoplasty to resolve these issues. Complications of radix augmentation include: 1) poor implant selection and size resulting in inadequate augmentation. 2) poor implant placement and not properly securing the implant resulting in movement and implant deviations, 3) improper plane dissection causing extrusion and visible surface deformities, and 4) infection.
The key to a successful nasofrontal augmentation lies in building a structure that fits those proportions and provides an aesthetic look in both frontal and profile views. When the surgeon accomplishes this procedure correctly the first time, the patient will have the appearance they desire without the need for Revision Rhinoplasty.
Augmentation of Radix and Naso-frontal angle in Ethnic patient using custom-carved SLUPimplant™.