Reply to: Invited Discussion on: Quality of Life and Outcome After Preservation Rhinoplasty Using the Rhinoplasty Outcome Evaluation Questionnaire

Overview

This is a correspondence piece rather than a study. The authors describe the nose's central position in the face and the impact of changing it on social relationships. They then outline the historical progression of surgical philosophy in the field and state their own position on how rhinoplasty should be approached.

Sections of note

• Reply to an invited discussion; the journal assigns level of evidence V.
• No patients, measurements, outcomes or follow up are reported.
• Most publications up to the end of the 1990s concerned the closed approach.
• The open approach then dominated discussion and comparison with the closed approach.
• The authors state that division has more recently faded as each surgeon personalizes their technique.
• Preservation rhinoplasty is described as a third philosophical approach, more conservative and less aggressive.
• It is stated to translate into two techniques, the push down and the let down.
• The authors credit Saban and Cakir with emphasizing the possibility of a smooth nasal contour after hump correction while leaving the area intact.

What it means for a patient

• The article records opinion and history; it contains no findings a patient can act on.
• The authors' stated goal is correcting imperfections and breathing problems while keeping the patient's own characteristics.
• Preservation rhinoplasty is credited with encouraging finer, less aggressive dissection generally.
• Discussion of the indications for the push down technique and its complications is described as ongoing.

Why this paper matters

Correspondence pieces record how a field frames its own development, and this one places preservation rhinoplasty as a third philosophy alongside closed and open approaches. It also acknowledges the debate over that technique is unsettled. It offers no evidence on any approach.

Terms

• Preservation rhinoplasty: keeping and repositioning existing structures rather than removing and rebuilding.
• Closed approach: surgery through incisions inside the nose only.
• Open approach: surgery through an incision across the columella, lifting the nasal skin.
• Push down and let down: two ways of lowering the bony framework of the nose.
• Level of evidence V: expert opinion, the weakest evidence category.