Step-up Maneuver for Radix Control in Dorsal Preservation Rhinoplasty

Overview

Controlling the radix, the root of the nose between the eyes, is a persistent concern in preservation rhinoplasty, since lowering the bridge can drop the root along with it. The authors present the step-up maneuver as a way to adjust radix height precisely while keeping structural integrity, and report a retrospective series of consecutive primary cases performed between 2022 and 2023.

Sections of note

• Design: retrospective series of 245 consecutive primary preservation rhinoplasties, 2022 to 2023.
• The subdorsal Tetris flap was used in 86.1 percent of cases; the low strip approach in 13.9 percent.
• Radix height was maintained in 91.0 percent, projected in 2.9 percent, deprojected in 6.1 percent.
• Stated claims: the maneuver broadens the indications for preservation rhinoplasty and reduces the risk of radix related complications.
• Stated implication: preservation can be safely extended to a wider range of nasal anatomies with lower revision rates.
• Outcomes are intraoperative, and no follow up length or revision data appear in the abstract.

What it means for a patient

• The root of the nose sits between the eyes and sets how long the nose appears, so an unintended drop there changes the whole profile.
• Height was preserved as planned in nine of ten cases, with the remaining cases split between too much and too little.
• The reported outcomes were recorded during surgery, so they describe what was achieved on the table rather than what held afterward.
• Limits: 245 patients, single practice, retrospective, no comparison group, and no follow up or revision data despite the claim of reduced revision rates.

Why this paper matters

Radix position is one of the constraints that limits which noses suit preservation, since the technique moves the whole bridge as a unit. A maneuver giving independent control of the root widens what is treatable. The claimed reduction in revision rates is asserted without follow up data supporting it.

Terms

• Radix: the root of the nose, the area between the eyes.
• Dorsal preservation rhinoplasty: lowering the bridge while keeping its natural surface intact.
• Tetris flap: a named subdorsal cartilage flap technique used in preservation rhinoplasty.
• Low strip approach: removing cartilage from the lower part of the septum to let the bridge settle.
• Deprojection: reducing how far a structure stands out from the face.
• Intraoperative outcome: a result recorded during surgery rather than at follow up.