Precision Segmental Preservation Rhinoplasty: Avoiding Widening, Defining New Dorsal Esthetic Lines in Dorsal Preservation Rhinoplasty

Overview

The authors describe worldwide enthusiasm driving a rapid increase in preservation surgery, accompanied by drawbacks and complications that led many surgeons to recoil and go back to classic removal techniques. Against that background they develop concepts intended to allow preservation in noses previously considered absolute contraindications.

Sections of note

• Technique and concept article; the abstract reports no patient numbers, no complication rates and no follow up.
• The authors state the rapid increase in preservation surgery promoted a considerable percentage of drawbacks and complications.
• Many surgeons are stated to have returned to classic resective techniques as a result.
• Presented strategies include redefining new dorsal aesthetic lines.
• Others are controlling the nasal side wall and the groove between nose and face.
• Avoiding widening of the middle vault is a further stated strategy.
• Precision in designing the bony and cartilaginous profile, avoiding irregularities, is also presented.

What it means for a patient

• The article's premise is that preservation rhinoplasty has a real complication burden, stated by advocates of the technique themselves.
• Widening of the middle of the nose is one of its characteristic problems and is a focus here.
• The proposed strategies aim to extend the technique to noses that were previously excluded from it.
• No results, rates or comparisons are reported.

Why this paper matters

Preservation rhinoplasty spread faster than its evidence, and this article documents the resulting retreat by some surgeons. It proposes refinements rather than defending the technique unqualified. Whether the proposed strategies reduce the named drawbacks has not been measured.

Terms

• Preservation rhinoplasty: keeping and repositioning existing structures rather than removing and rebuilding.
• Resective technique: surgery that removes tissue, here the hump.
• Dorsal aesthetic lines: the two shadow lines running down the bridge from the brows to the tip.
• Midvault widening: the middle third of the nose becoming broader after surgery.
• Nasofacial groove: the crease where the side of the nose meets the cheek.
• Contraindication: a reason a particular technique should not be used in a given patient.