"Radix Pillow" Constructs with Fascial Extension for Radix Augmentation in Primary Rhinoplasty

Overview

Temporal fascia and diced cartilage are commonly used in combination to augment the radix, the deep point between the eyes. The authors state that despite extensive literature on variations, practical detail on how to construct and place these grafts is lacking. This article supplies that detail.

Sections of note

• Temporalis fascia and diced cartilage in varying combinations are currently common for radix augmentation.
• The authors state existing literature is replete with papers and variations but lacks practical detail on execution.
• The technique is a reproducible multilayered pillow construct of temporalis fascia, for selective radix augmentation in primary rhinoplasty.
• Diced cartilage may be added or omitted.
• Precise measurements for accurate multiple folding are described as key.
• Exact tailoring of the construct to the size of the recipient area is also key.
• Fixation uses a litter concept with proximal and distal fixation points. Level of evidence IV. No patient numbers, outcomes, or follow-up are reported.

What it means for a patient

• The radix is the deepest point of the bridge, and building it up changes the apparent length and starting height of the nose.
• The graft is folded fascia rather than cartilage, so it is soft and unlikely to show an edge.
• Fixing it at both ends is intended to stop it shifting or bunching.
• This is a technique article with no data, so it reports no resorption rates or how long the augmentation lasts.

Why this paper matters

Radix augmentation is a small change with a large effect on how the whole profile reads, and graft migration or resorption there is visible. Precise construction and fixation detail is what makes a technique repeatable between surgeons. No outcome data accompanies the description.

Terms

• Radix: The root of the nose, the deepest point between the eyes.
• Temporalis fascia: The fibrous layer over the muscle at the temple, a common graft source.
• Diced cartilage: Cartilage cut into very small pieces and used as a mass.
• Augmentation: Building up a structure to add height or volume.
• Fixation point: Where a graft is stitched to hold its position.