Why a high radix makes the nose look artificial: septal reconstruction and radix correction methods

Hello, I am Dr. Peter C. Kang.

Today, I would like to share the case of a patient who visited our clinic concerned about a severe deviated septum and an unnatural nasal appearance caused by an excessively high radix.

About 5 years ago, the patient underwent a prior surgery involving nasal bridge augmentation with a silicone implant and nasal tip surgery using septal cartilage.

• Approximately 5 years ago: silicone implant bridge surgery + septal cartilage tip surgery

Following the surgery, the septal deviation worsened, and the starting point of the bridge implant was placed excessively high, making the nasal bridge appear unnatural. In addition, the patient was dissatisfied with the overall nasal contour due to a crooked appearance. This was accompanied by nasal obstruction, causing functional difficulties as well.

The patient's specific requests were as follows:

• Desire to address both functional and aesthetic concerns simultaneously

• Desire to lower the radix while achieving a natural dorsal line

• A rounded yet well-defined nasal tip (without a sharp look)

• Preventing the nose from appearing upturned from the front view

• A feminine straight bridge line

• Preference for using donor rib cartilage

In particular, the patient wished to improve the artificial appearance caused by the high radix and wanted a tip that looked softly rounded yet defined and natural, rather than sharp. Additionally, the patient hoped to resolve the nasal obstruction to achieve comfortable breathing functionally.

1. Septal reconstruction and correction using donor rib cartilage

• Reconstruction of the severely deviated septum using donor rib cartilage

• Restoration of structural stability in the septum

• Fundamental relief of nasal obstruction by normalizing internal nasal airflow

2. Nasal bridge alignment via lateral osteotomy

• Correction of a nasal bridge with a high radix and crooked appearance

• Repositioning of the nasal bones to establish a natural radix

• Straightening and refining the overall nasal bridge line

3. Silicone implant replacement

• Removal of existing silicone implant

• Precise carving of a new implant with a lowered radix to match the nasal bone

• Setting a natural bridge height suited for a feminine straight bridge line

4. Corrective surgery for deviated septum and rhinitis

• Straightening the deviated septum through septoplasty

• Alleviating rhinitis symptoms through inferior turbinate reduction

• Securing daily comfort through functional breathing improvement

Front view changes

• The previously high radix is naturally lowered, creating a softer impression

• The crooked nasal bridge is properly straightened

• A stable shape where the nose no longer appears upturned from the front view

Profile view changes

• The radix is naturally lowered, forming a smooth transition from the forehead to the nose

• Feminine straight bridge line achieved

• A refined nasal tip that is rounded yet well-projected

Changes on the oblique view

• A natural, harmonious nasal contour seen at a 45-degree angle

• A balanced line connecting the nasal bridge and tip

• An overall refined nasal shape that complements the face

Changes in nostril shape

• Nostril contours are naturally refined alongside tip improvement

• Balanced, symmetric nostril shape

• An overall stable nasal base contour

This presentation involves cases where septal deviation worsened after a prior surgery and the radix of the bridge implant was placed excessively high, resulting in an unnatural nasal shape. Resolving such complex concerns requires a systematic surgical plan that addresses both functional correction and aesthetic improvement at the same time.

Especially when septal deviation is severe, the remaining septal cartilage alone may be insufficient for reconstruction. In this procedure, donor rib cartilage was used to reconstruct the septum, securing adequate structural support while resolving the underlying cause of the nasal obstruction. Donor rib cartilage provides sufficient strength and support without the need to harvest autologous rib cartilage, reducing physical strain on the patient while enabling stable septal reconstruction.

A high radix is a relatively common concern encountered in revision rhinoplasty. When the starting point of the implant is positioned too high near the glabella, the nose can look artificial and unnatural. In this surgery, the existing implant was removed and the radix was lowered appropriately by precisely carving a new implant to match the nasal bones. This allowed us to create a smooth, natural transition from the forehead to the nasal bridge.

Furthermore, lateral osteotomy was performed to correct the crooked nasal bridge, and septoplasty was combined with inferior turbinate reduction to comprehensively resolve the nasal obstruction. Because revision rhinoplasty must account for scar tissue and altered structural anatomy from previous surgeries, it requires an even more meticulous approach than a primary procedure.

In complex revision rhinoplasty cases like this, I do my best to satisfy both the functional and aesthetic needs of the patient. I hope this case serves as a helpful reference for anyone experiencing similar concerns.

This was Dr. Peter C. Kang. Thank you.

#closedrhinoplasty #closedrevisionrhinoplasty #revisionrhinoplasty #deviatedseptum #septalreconstruction #donorribcartilage #lateralosteotomy #radixcorrection #implantreplacement #nasalobstructionsurgery