Decision Making in Preservation Rhinoplasty: A 100 Case Series With One-Year Follow-Up

Overview

Preservation rhinoplasty, a term coined in 2018, reshapes the nose by keeping structures intact rather than removing and rebuilding them. This retrospective single-surgeon series records which structures were actually preserved in practice and in what combinations.

Sections of note

• 153 primary rhinoplasty cases studied retrospectively between December 2016 and August 2017; 100 had at least 1 year of follow-up.
• Technical details recorded included dissection plane, ligament preservation, tip support, lateral crural maneuvers, alar contour grafts, and dorsal preservation versus traditional reduction.
• All patients had open rhinoplasty; average follow-up 13 months.
• All patients had preservation of the dorsal soft tissue envelope; in 36 the entire soft tissue envelope and ligaments were preserved.
• 54 had preservation of the alar cartilages; 31 had dorsal preservation.
• Combinations: complete preservation of skin, dorsum and alars in 24; skin and dorsum in 2; alars and dorsum in 2; skin and alars in 7.
• Conclusions: preserve the lateral crura where possible and choose tensioning over excision; dorsal preservation is versatile with proper patient selection. Level of evidence 4.

What it means for a patient

• Preservation is not all or nothing: different parts of the nose can be preserved independently.
• Complete preservation, where nothing is removed and the structures are reshaped in place, applied to 24 of 100 patients.
• Preserving the bridge is described as avoiding long-term problems at the middle vault and keystone area.
• Limits: one surgeon, retrospective, no comparison group against conventional technique, no outcome scores, and average follow-up of 13 months.

Why this paper matters

Preservation rhinoplasty grew rapidly in the years after this paper, and this documents how the approach was actually applied case by case. It shows selection matters: fewer than a third had dorsal preservation. The abstract reports what was done rather than how the results compared.

Terms

• Preservation rhinoplasty: Reshaping the nose while keeping existing structures intact.
• Dorsal soft tissue envelope: The skin, fat and muscle layer covering the bridge.
• Lateral crus: The outer arm of the tip cartilage.
• Tensioning: Reshaping cartilage by putting it under tension rather than cutting it out.
• Keystone: The junction where the nasal bones meet the cartilage of the middle nose.