Patient Satisfaction following Structural versus Preservation Rhinoplasty: A Systematic Review

Levin M, Ziai H, Roskies M.

What this paper says

Of 29 studies measuring rhinoplasty satisfaction from 2010 to 2020, 25 addressed structural technique and only 4 addressed dorsal preservation, with 56 percent and 25 percent respectively reporting statistically significant improvement.

Overview

Dorsal preservation has gained acceptance among facial plastic surgeons, but the satisfaction evidence supporting it is thin. This systematic review searched for all studies quantifying satisfaction after either technique and compared what has been published for each.

Sections of note

OVID Medline, EMBASE and PubMed were searched for studies from 2010 to 2020 evaluating satisfaction after structural or dorsal preservation rhinoplasty.
2,172 articles were initially identified; 29 were included in the final analysis.
Of the 29, 25 focused on structural rhinoplasty and 4 on preservation rhinoplasty.
Among the 25 structural studies, 17 used the Rhinoplasty Outcome Evaluation questionnaire and 5 used FACE-Q.
14 of the 25 structural studies, 56 percent, reported statistically significant improvements in satisfaction scores.
1 of the 4 preservation studies, 25 percent, reported significant improvement.
Most studies included a statement that satisfaction improved, and the authors call for more research quantifying satisfaction after preservation and prospectively comparing the two techniques.

What it means for a patient

Preservation rhinoplasty has been adopted widely on the strength of four satisfaction studies, only one of which showed a statistically significant improvement.
Even for the established structural technique, only just over half of studies demonstrated significant improvement statistically.
Many studies asserted improvement without showing it statistically.
Limits: this counts and classifies published studies rather than pooling their results, and the two groups of studies are not directly comparable.

Why this paper matters

Dorsal preservation spread faster than the evidence supporting it, and this quantifies how thin that evidence is. The gap between what studies claim and what they demonstrate statistically applies to both techniques. A prospective head-to-head comparison does not exist.

Terms

Structural rhinoplasty: Taking the framework apart and rebuilding it with grafts and sutures.
Dorsal preservation rhinoplasty: Lowering the bridge as a single unit rather than removing its surface.
Rhinoplasty Outcome Evaluation: A validated six-question satisfaction questionnaire.
FACE-Q: A modular validated questionnaire covering facial appearance outcomes.
Systematic review: A structured search and appraisal of all studies on a question.

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

From the abstract

“Recently, dorsal preservation rhinoplasty has been gained acceptance among facial plastic surgeons. Despite this, there is limited literature on patient satisfaction following preservation rhinoplasty. This systematic review aims to evaluate all studies quantifying patient satisfaction and to compare results between…”

Excerpt; the full abstract is on PubMed.