History of Dorsum Conservative Techniques in Rhinoplasty: The Evolution of a Revived Technique

Overview

Hump correction has been the central problem of cosmetic rhinoplasty since its beginning. Joseph's resection technique became standard but has drawbacks if done poorly. In parallel, a dorsal-conservative method arose that lowered the hump without damaging the keystone or separating the upper lateral cartilages from the septum. The authors (including Neves and D'Souza) review the history and evolution of this technique and its rebirth. No patient data are presented.

Sections of note

• Joseph's resective technique was the long-standing standard for hump reduction.
• A conservative dorsal technique was born in the late 19th and early 20th centuries.
• Its defining features: keystone area untouched; dorsal connection between upper lateral cartilage and septum preserved.
• The technique was abandoned for decades and then revived and refined.

What it means for a patient

• "Preservation rhinoplasty" is not new; it is a century-old idea (associated with Goodale, Lothrop and Cottle) that modern instruments and understanding have brought back.
• Knowing the history helps a patient weigh claims that it is a revolutionary or untested approach: it is neither.

Why this paper matters

It supplies the historical context for the preservation movement from surgeons active in its revival. Limits: narrative history, no data.

Terms

• Dorsal conservative (preservation) technique: lowering the hump by moving the intact bridge down rather than cutting it off.
• Joseph technique: Jacques Joseph's early-20th-century method of resecting the hump.
• Keystone area: the junction of nasal bones, upper lateral cartilages and septum on the bridge.
• Resective rhinoplasty: surgery that removes tissue to reshape.