Dorsal Preservation Rhinoplasty in Asian Hump Noses

Overview

Dorsal preservation keeps the junction of bone and cartilage and the keystone area intact while lowering the bridge, and has spread in Western practice for hump correction. The authors report on its feasibility in Asian hump noses, which differ in skin thickness and cartilage strength. They retrospectively reviewed charts, operative records and standardized photographs of nine patients operated on by the senior author from March 2019 to December 2021.

Sections of note

• Design: retrospective case series, nine patients, single senior surgeon.
• All operations used an open approach.
• Bone maneuver: push-down in 3 patients, let-down in 6.
• All patients had tip modification, with or without radix grafting, alongside the dorsal preservation.
• Bony step-off camouflage at the transverse osteotomy site was required in 3 of 9 patients.
• Both the nasofacial and rhinion angles changed significantly after surgery, p equal to 0.008.
• Hump reduction succeeded in all cases with no recurrence and no saddle nose, and no major complications occurred.
• All patients were reported satisfied with aesthetic and functional results, with no scoring tool named.

What it means for a patient

• Preservation techniques appear workable on Asian hump noses, which are less often the subject of this literature.
• A third of patients needed extra camouflage over a bony step, so the transition at the bone cut is the recurring weak point.
• The authors state a preference for the open approach in these noses, along with planned management of septal cartilage since the tip also needs work.
• Limits: nine patients, one surgeon, retrospective, no comparison group, no validated satisfaction questionnaire and no stated follow up length.

Why this paper matters

Preservation rhinoplasty developed largely on European noses, and its behavior under thicker skin with weaker cartilage is not assumed to be the same. This series is an early feasibility report for a different population. Nine patients cannot establish recurrence rates or durability.

Terms

• Dorsal preservation: lowering the bridge while keeping its natural surface intact.
• Keystone area: where the nasal bones meet the upper lateral cartilages and septum.
• Push-down and let-down: lowering the bridge by sinking it or by removing a bone wedge first.
• Saddle nose: a collapsed bridge that dips in the middle.
• Radix: the root of the nose, the area between the eyes.
• Step-off: a palpable or visible ledge at the edge of a bone cut.