A Review and Modification of Dorsal Preservation Rhinoplasty Techniques

Patel PN, Abdelwahab M, Most SP.

PubMed 32130066 Publisher (DOI)Free full text (PMC)

What this paper says

A review of dorsal preservation rhinoplasty, which lowers the bridge as a single unit rather than removing it, noting pleasing bridge lines but a higher rate of hump recurrence and an absence of patient-reported outcome data.

Overview

Conventional rhinoplasty removes the hump and then rebuilds the middle vault. Dorsal preservation instead mobilizes the whole bone and cartilage roof and lowers it, keeping the keystone junction intact. This review sets out the techniques, the variants, and what is and is not known about outcomes.

Sections of note

Dorsal preservation mobilizes the osseocartilaginous nasal vault as a single unit, preventing disruption of the natural keystone area.
The bony vault is managed with a transverse osteotomy plus either bilateral single lateral osteotomies, the pushdown procedure, or bilateral bony wedge resections, the letdown procedure.
Septal approaches differ by where cartilage is removed: subdorsal, high-septal, midseptal, or inferior septum.
These techniques produce pleasing dorsal aesthetic lines but may be limited by a higher rate of dorsal hump recurrence.
Patency of the internal nasal valve is theoretically improved with dorsal preservation.
Robust series with patient-reported outcomes are lacking; the authors' early experience with a high-septal resection technique suggests positive functional and cosmetic results.
The authors call for critical assessment of patient-reported outcomes and objective measurements compared against standard hump takedown.

What it means for a patient

The natural surface of the bridge is kept rather than shaved and rebuilt, which is why the bridge lines look smooth.
The recognized trade-off is that the hump can come back.
The claimed breathing benefit is described as theoretical, not demonstrated.
This is a review with no outcome data, and the authors themselves state the comparative evidence does not yet exist.

Why this paper matters

Dorsal preservation spread rapidly on claims of superior results, and this review states plainly that comparative patient-reported evidence is missing. Setting out the technical variants clearly is useful. The comparison against conventional hump removal remains the open question.

Terms

Dorsal preservation: Lowering the bridge as a single unit rather than removing its surface.
Osseocartilaginous vault: The combined bone and cartilage roof of the nose.
Keystone: The junction where the nasal bones meet the cartilage of the middle nose.
Pushdown and letdown: The two ways of allowing the nasal roof to descend, with or without removing a bony wedge.
Internal nasal valve: The narrowest part of the nasal airway.

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

Abstract

Importance: Although conventional hump resections are a hallmark of rhinoplasty, there has been a rekindled interest in dorsal preservation (DP) techniques as a means for addressing the dorsal hump, with claims of superior functional and aesthetic results. As such, an understanding of DP, including technical considerations and outcomes, is imperative. Observations: DP allows for mobilization of the osseocartilaginous nasal vault as a single unit and thereby prevents disruption of the natural keystone area. The osseous nasal vault is managed with a transverse osteotomy and either a bilateral single lateral osteotomy (pushdown procedure) or bilateral bony wedge resections (letdown procedure) to allow for descent of the nasal dorsum. A variety of approaches to the septum exist, each differentiated by the location of cartilage resection: subdorsal, high-septal, midseptal, or inferior septum. These techniques result in pleasing dorsal aesthetic lines but may be limited by a higher rate of dorsal hump recurrence. Patency of the internal nasal valve (INV) is theoretically improved with DP. Robust series with patient-reported outcomes are lacking, although several reports and early experience at our center with a newly described high-septal resection technique do suggest positive functional and cosmetic outcomes with DP. Conclusions and Relevance: With the recent revitalized interest in DP, an understanding of the potential benefits, techniques, and challenges associated with this surgery is helpful. Maintenance of the dorsum as a single unit has implications for maintaining structural integrity at the nasal keystone, pleasing dorsal aesthetic lines, and the patency of the INV. As surgeons continue to develop and employ these techniques, critical assessment of patient-reported outcomes and objective nasal measurements, with an emphasis on comparison with standard hump takedown techniques, will be valuable.

Abstract as indexed by PubMed; the article is open access (PubMed Central).