title: Preventing Elevated Radix Deformity in Asian Rhinoplasty with a Chimeric Dorsal-Glabellar Construct.
abstract: BACKGROUND
  Asian facial aesthetic surgery should enhance, but not change, natural features. Augmentation rhinoplasty is a hallmark of Asian cosmetic surgery. In the authors' experience, I-shaped implants can elevate and efface the radix, leading to an unnatural appearance (elevated radix deformity).
  
  
  OBJECTIVE
  The Chimeric technique was developed to control final radix position and preserve the nasal profile. We aim to demonstrate that the Chimeric technique promotes forward projection, not elevation, of the radix.
  
  
  METHODS
  Between 2013 and 2015, 49 patients underwent rhinoplasty with I-shaped implants. Nineteen patients had Chimeric dorsal-glabellar implants, 30 did not. Standardized photographs were obtained at every visit. Novel and established photogrammetric parameters were used to describe radix position and position change. A retrospective chart review provided additional procedural details and outcomes data.
  
  
  RESULTS
  Patients were followed for 10.8 months (range, 2-36 months). Nasal height increase (113% vs 107%) and bridge length increase (118% vs 105%) were significantly greater when the Chimeric technique was not performed (P < .0001). The nasofrontal angle increased 6° in both groups; there was no difference between groups. The vector of radix position change was 26.1° in the Chimeric group and 63.4° in the traditional group (P < .0001).
  
  
  CONCLUSIONS
  The Chimeric technique preserves the nasal profile with a favorable (horizontal) radix transposition vector. There was not a significant difference in final radix position when Chimeric rhinoplasty was performed because that is controlled by implant thickness and position. The technique did not blunt the radix significantly. LEVEL OF EVIDENCE 4: Therapeutic.
authors.affiliation: Dr Zelken is a plastic surgeon in private practice in Newport Beach, CA, USA. Dr Hong is a Clinical Professor, Department of Plastic and Reconstructive Surgery, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea. Dr Broyles is a Resident, Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. Dr Hsiao is an Assistant Professor, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Zelken
authors.affiliation: Dr Zelken is a plastic surgeon in private practice in Newport Beach, CA, USA. Dr Hong is a Clinical Professor, Department of Plastic and Reconstructive Surgery, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea. Dr Broyles is a Resident, Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. Dr Hsiao is an Assistant Professor, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan.
authors.forename: Joon Pio
authors.initials: JP
authors.lastname: Hong
authors.affiliation: Dr Zelken is a plastic surgeon in private practice in Newport Beach, CA, USA. Dr Hong is a Clinical Professor, Department of Plastic and Reconstructive Surgery, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea. Dr Broyles is a Resident, Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. Dr Hsiao is an Assistant Professor, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Broyles
authors.affiliation: Dr Zelken is a plastic surgeon in private practice in Newport Beach, CA, USA. Dr Hong is a Clinical Professor, Department of Plastic and Reconstructive Surgery, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea. Dr Broyles is a Resident, Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. Dr Hsiao is an Assistant Professor, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan.
authors.forename: Yen-Chang
authors.initials: YC
authors.lastname: Hsiao
mesh_terms: D000293:Adolescent; D000328:Adult; D059925:Anatomic Landmarks; D044466:Asian People; D004954:Esthetics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000033:anatomy & histology / Q000601:surgery*; D009667:Nose Deformities, Acquired / Q000208:ethnology / Q000517:prevention & control*; D010781:Photography; D019736:Prostheses and Implants; D011474:Prosthesis Design; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000009:adverse effects / Q000295:instrumentation*; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult