A Practical Classification System for Dorsal Preservation Rhinoplasty Techniques

Overview

The authors state that preservation rhinoplasty, and dorsal preservation in particular, is among the most discussed and most confusing topics in modern rhinoplasty. Meetings and publications have driven interest in these old and new techniques. Newer preservation strategies have wider indications than the original push down and let down. The authors argue a simple classification is needed to clarify what preservation means.

Sections of note

• Viewpoint article; the abstract reports no patient numbers, no outcomes and no follow up.
• The authors note new preservation strategies have a broader range of indications than the older push down and let down.
• They pose the question of whether all preservation variations can be systematized in a simple classification, and answer yes.
• The proposed classification is stated to cover all kinds of preservation techniques, both old and new.
• Classifying preservation is said to clarify the relative position of all techniques.
• The stated purpose is to allow comparison of procedures from similar families, and of their outcomes and indications.

What it means for a patient

• The number of named preservation techniques has grown faster than the evidence comparing them.
• A shared classification is a prerequisite for comparing results across studies.
• This article proposes a framework. It reports no clinical data.

Why this paper matters

Comparing outcomes between preservation techniques has been difficult because different names describe overlapping operations. A classification is the step that makes such comparison possible. Whether this particular scheme is adopted, and whether it improves outcome research, is not yet known.

Terms

• Dorsal preservation: lowering the natural nasal bridge instead of cutting the hump off.
• Push down: lowering the nasal framework into the face after releasing it.
• Let down: lowering the framework after removing a wedge of bone at each side.
• Classification system: an agreed scheme for grouping related techniques.
• Indication: the situation in which a particular technique is appropriate.