Management of the nasal dorsum in rhinoplasty: a systematic review of the literature regarding technique, outcomes, and complications

Lee MR, Unger JG, Rohrich RJ.

PubMed 22030516 Publisher (DOI)

What this paper says

A systematic review of 83 studies from 1950 to 2010 found that building up the nasal bridge with the patient's own cartilage, bone or soft tissue gives acceptable results with few complications, synthetic implants carry more displacement and extrusion, and nearly all the evidence is low level.

Overview

The bridge of the nose can be reduced or built up in many ways, and surgeons disagree about which is best. The authors searched the literature for any study reporting outcomes or complications of a dorsal technique, to see what the published data actually support.

Sections of note

Search of MEDLINE via OVID, PubMed and the Cochrane database for articles from January 1, 1950 to September 1, 2010.
5,437 articles returned; 115 selected on abstract review; 59 met inclusion criteria; 24 more found by supplementary search, for 83 total.
89% of studies covered augmentation; 13% covered reduction; some covered both.
Augmentation with cartilage, bone and soft tissue: acceptable results, generally low complication levels.
Synthetic implants such as Gore-Tex and silicone: higher complication rates including displacement and extrusion, overall acceptable results.
Reduction: many approaches, mostly satisfactory results.
The vast majority of data is low-level evidence; level of evidence for the review: therapeutic, IV.

What it means for a patient

Six decades of publications support the patient's own tissue as the lower-risk choice for raising the bridge.
Synthetic implants work for most patients but shift or come through the skin more often.
Almost no study compared techniques head to head, so the ranking rests on case series rather than trials.

Why this paper matters

It quantifies how weak the evidence base for dorsal surgery is and calls for level II or III studies. It does not produce pooled complication rates and predates the dorsal preservation movement.

Terms

Nasal dorsum: the bridge of the nose.
Systematic review: a structured search and appraisal of all studies on a question.
Augmentation: adding graft or implant to raise the bridge.
Extrusion: an implant or graft working its way out through skin or lining.
Gore-Tex: a brand of expanded polytetrafluoroethylene, a porous synthetic implant.
Level of evidence: a grading of study quality; level IV is a case series, levels II and III involve comparison groups.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Few operations in plastic surgery have generated as much discussion and debate as that of rhinoplasty. The aim of this review is to explore the existing body of literature with regard to techniques addressing the nasal dorsum. The authors' attempt was to isolate those articles providing either retrospective or…”

Excerpt; the full abstract is on PubMed.