Classification and Treatment of Glabella-Radix Deficiency in Primary Augmentation Rhinoplasty

Abstract

Abstract Background A systematic approach to treating glabella-radix deficiency is lacking, and the management of brow-tip aesthetic lines remains technically challenging. Objectives The authors describe implantation of a customized Gore-Tex prosthesis combined with primary augmentation rhinoplasty to address the glabella-radix deficiency. Methods Fifty Asian patients with glabella-radix deficiency who received implantation and primary augmentation rhinoplasty were retrospectively evaluated in an 8-year period. Patients were assigned to categories based on brow-tip contour lines and symmetry patterns, and implant dimensions were ascertained from the contour type and from simulated postoperative results. Results Eleven men and 39 women were included in the study; the mean patient age was 27.22 years, and mean follow-up was 22.8 months. Seven of the patients were assigned to the type I/Ia category, 24 to type II/IIa, and 19 to type III/IIIa. Forty-five patients were considered to have satisfactory surgical results, with curved, symmetric, and normally spaced brow-tip lines on front view and a smooth frontonasal transition on profile view. Complications occurred in 5 patients and included infection (1 patient), inadequate augmentation (2), and palpable margin folding of the Gore-Tex device (2). Conclusions Deformities of brow-tip contour lines coincide with glabella-radix deficiencies in terms of severity. Knowledge of the patterns of brow-tip lines, combined with postoperative image simulation, can help the surgeon design an appropriate glabella-radix prosthesis. When placed in conjunction with other augmentation rhinoplasty procedures, the glabella-radix implant yields sufficient, predictable nasal projection and a harmonious facial aesthetic. Level of Evidence: 4