Preservation Rhinoplasty: Evolution and Current State of Practice in the United States

Overview

Classic Joseph hump reduction has been the standard of rhinoplasty practice and teaching, while preservation techniques described by Goodale, Lothrop and Cottle in the late nineteenth and early twentieth centuries were never adopted as widely as open structural approaches. The authors state this left a shortage of research and teaching on preservation, particularly in the United States. They surveyed members of the American Academy of Facial Plastic and Reconstructive Surgery and The Rhinoplasty Society.

Sections of note

• Survey of 145 respondents from two American surgical societies, presented alongside a historical review.
• Fifteen respondents, 10 percent, were not at all familiar with dorsal preservation surgery; 130, 90 percent, were familiar.
• Among those familiar, the majority, 84 or 65 percent, were only somewhat familiar.
• Only 11 respondents received any formal training in dorsal preservation during residency or fellowship.
• Sixty one, 42 percent, had attended a course or conference where the techniques were discussed.
• One hundred and twenty two respondents, 84.1 percent, do not currently use preservation techniques in practice.
• Twelve, 8 percent, use it in under 25 percent of cases; 5, 3 percent, in 25 to 50 percent; and 6, 4 percent, in over 50 percent.

What it means for a patient

• Most American facial plastic surgeons surveyed did not perform dorsal preservation at the time of the survey.
• Familiarity came mainly from courses rather than formal training.
• Survey respondents self select, so the figures may not represent all surgeons.
• A patient seeking preservation rhinoplasty in the United States would have been choosing from a small group of surgeons using it routinely.

Why this paper matters

Technique adoption in surgery depends on training pathways as much as on evidence. This survey documents the gap between awareness of dorsal preservation and its actual use. Whether adoption has since increased is not answered by a single point survey.

Terms

• Dorsal preservation: lowering the natural nasal bridge instead of cutting the hump off.
• Joseph hump reduction: the classic technique of cutting the hump away, named after Jacques Joseph.
• Structural rhinoplasty: rebuilding the framework with grafts and sutures after removing tissue.
• Residency and fellowship: the formal training stages after medical school.