The Radix Suture: A Strategy for Prevention of Soft Tissue Fullness After Radix Reduction in Rhinoplasty

Abstract

Traditional rhinoplasty techniques primarily address the osseocartilaginous framework; however, the final aesthetic outcome also depends on the skin–soft tissue envelope (SSTE) and its ability to redrape. In patients undergoing reduction of a high radix, early postoperative edema or hematoma related to dead-space formation can promote fibrosis and skin thickening, contributing to secondary increases in radix height and width. This represents a significant aesthetic concern that remains insufficiently addressed. We describe a novel transosseous radix fixation suture designed to prevent postoperative radix height increase following dorsal hump reduction with radix lowering. The technique involves the creation of a transverse transosseous tunnel at the radix. An absorbable suture is passed through the tunnel and sequentially externalized through four discrete cutaneous puncture sites, enabling reapproximation of the SSTE to the underlying periosteal and deep soft-tissue planes and dead-space reduction. The technique was applied in 30 patients and compared with a control cohort. At the 12-month follow-up, the change in nasofrontal angle (NFA) was significantly smaller in the radix-suture group than in controls (ΔNFA: 4.0 ± 3.8° vs. 6.2 ± 3.3°; p = 0.02). Patient-reported satisfaction, measured by the Rhinoplasty Outcomes Evaluation, was higher in the radix-suture group (94 ± 3% vs. 90 ± 4%).