Functional and Aesthetic Outcomes of No-Dissection Nasal Dorsum Using Subdorsal Septal Excision in Preservation Rhinoplasty

Qaradaxi KA, Mohammed AA.

PubMed 36827472 Publisher (DOI)Free full text (PMC)

What this paper says

Among 113 patients whose humps were lowered by preservation rhinoplasty with almost no dissection of the bridge, about 96 percent improved on a combined appearance and breathing questionnaire, with complications in 22.11 percent.

Overview

Dorsal preservation lowers the nasal hump without removing the surface of the bridge. The authors went further, leaving the soft tissue covering the bridge largely undissected, on the argument that this gives a smoother result, a faster operation and less swelling. They ran a prospective study of 113 hump patients and scored results with the Standardized Cosmesis and Health Nasal Outcomes Survey.

Sections of note

Design: prospective study of 113 patients, single practice. Level of evidence therapeutic IV.
The hump was lowered by an average of 4.4 millimeters.
Mean preoperative SCHNOS total score was 7.21, with an obstruction subscore of 2.95 and an aesthetic subscore of 4.27.
About 96 percent improved on the overall score; 98 patients or 86.7 percent improved on obstruction and 108 patients or 95.6 percent on appearance, all significant at p reported as 0.000.
Complications occurred in 22.11 percent: residual hump 13.27 percent, dorsal indentation 5.31 percent, bleeding 2.65 percent, granuloma at the osteotomy site 0.88 percent.

What it means for a patient

Most patients in this series reported both a better looking and a better breathing nose.
The complication figure deserves attention. Roughly one in eight had some hump left, which is the recognized weak point of preservation techniques.
The authors describe the risk of complications as very low while reporting 22.11 percent overall, so their conclusion sits awkwardly with their own number.
Limits: no comparison group, single practice, and no stated follow up length in the abstract.

Why this paper matters

Preservation rhinoplasty is promoted for smooth, natural bridges without the irregularities that follow hump removal. This series supplies patient reported scores across a reasonable sample. It does not compare preservation with conventional hump reduction, and it does not report how many patients needed revision for the residual humps.

Terms

Dorsal preservation: lowering the bridge while keeping its natural surface intact.
Subdorsal septal excision: removing a strip of septum from beneath the bridge so it can settle lower.
SCHNOS: a validated questionnaire scoring both nasal appearance and nasal blockage.
Dorsal indentation: a dip or hollow along the bridge after surgery.
Granuloma: a small lump of inflammatory tissue forming during healing.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Background: Dorsal preservation (DP) caused privilege change in the concept of rhinoplasty and a promising superior functional and aesthetic transformation in rhinoplasty surgery. Avoiding dissection of the dorsal nasal bone and cartilage will leave the soft-tissue envelope intact, leading to a fine and smooth appearance, faster operation with less subsequent edema, and overall preservation of the dorsal aesthetic line.

Methods: This prospective study included 113 patients who underwent DP rhinoplasty for nasal hump treatment with minimum dissection of nasal dorsum soft-tissue envelope. Results were evaluated using the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS).

Results: The mean preoperative SCHNOS score was 7.21; the mean obstructive score was 2.95 ± 1.068 and the mean aesthetic score was 4.27 ± 0.771. The average lowering of the dorsal hump was 4.4 mm. Approximately 96% of patients showed improvement in the SCHNOS score after surgery, 86.7% (98 patients) showed improvement in the obstructive symptoms and 95.6% (108 patients) showed improvement in the aesthetic score. Complications were seen in 22.11% (most commonly residual hump in 13.27% of cases and dorsal indentation in 5.31%), bleeding was seen in 2.65%, and granuloma formation at the dorsal osteotomy site was seen in 0.88%. There was a very significant improvement in the aesthetic, obstructive, and overall SCHNOS score ( P = 0.000) for each parameter.

Conclusions: DP rhinoplasty is a safe and very effective procedure, with very low risk of complications. Most of the treated patients have improvement of the obstructive and aesthetic outcome after surgery.

Clinical Question/Level Of Evidence: Therapeutic, IV.

Abstract as indexed by PubMed; the article is open access (PubMed Central).