Modified Dorsal Split Preservation Hybrid Rhinoplasty for Cartilaginous Pushdown and Full Letdown Applications: A PROM-Based Review of 100 Consecutive Cases

Overview

Preservation rhinoplasty lowers the bridge without removing its surface. This article describes a hybrid variation: the middle vault is split along a plane the authors call the Septal T, which lets the bridge be reshaped while the dorsal keystone area, where the nasal bones meet the cartilage, is left undisturbed. The septum is handled with conventional L strut septoplasty. The concept is applied both to cartilaginous pushdown and to full letdown.

Sections of note

• Design: retrospective analysis of 100 consecutive patients, reported as based on patient reported outcome measures.
• Technique: the middle vault is split along the Septal T plane and reshaped, while the dorsal keystone area is maintained.
• The septum is addressed separately by conventional L strut septoplasty.
• The high middle strip is fixed with direct sutures after flexing the bone and cartilage junction at the K area.
• Reported result: aesthetic and functional improvement. No scores, percentages, complication rates or follow up length appear in the abstract.

What it means for a patient

• This is a middle path between fully preserving the bridge and removing it, keeping the surface while allowing more reshaping than pure preservation permits.
• The abstract says outcomes were patient reported but does not name the questionnaire or give any numbers, so the size of the improvement cannot be judged from it.
• Limits: retrospective, single practice, consecutive series with no comparison group, and no stated follow up period.

Why this paper matters

Preservation rhinoplasty struggles when the bridge is wide, crooked or irregular, because keeping the surface limits what can be changed. Hybrid techniques that split and reshape the middle vault answer that limit. Whether this variation produces fewer irregularities or revisions than pure preservation or conventional hump removal is not tested here.

Terms

• Dorsal preservation: reshaping that keeps the natural surface of the nasal bridge.
• Middle vault: the middle third of the nose, formed by the upper lateral cartilages and septum.
• Keystone area: where the nasal bones overlap the upper lateral cartilages and septum.
• Pushdown and letdown: lowering the bridge by sinking it or by removing a bone wedge first.
• L strut septoplasty: straightening the septum while leaving an L shaped strip for support.