Comparison in Patient Satisfaction Between Structural Component and Hybrid T-bar Preservation Rhinoplasty: A Retrospective Propensity Score Matched Cohort Study

Verkest V, Pingnet L, Van Hout G, Fransen E, Declau F.

PubMed 37069352 Publisher (DOI)Free full text (PMC)

What this paper says

Comparing 110 patients treated with a T-bar preservation technique against 62 treated with the standard component reduction, appearance and breathing satisfaction were similar at six months.

Overview

Dorsal T-bar preservation separates the upper lateral cartilages from the septal T-bar, keeping the elastic keystone area intact while still reshaping the middle of the nose. The authors compared it against dorsal split component reduction, which they call the gold standard. They used propensity score matching, a statistical method that pairs patients on background characteristics so groups can be fairly compared.

Sections of note

Design: retrospective propensity score matched cohort study. Level of evidence III.
234 patients enrolled; 172 retained after matching, 110 in the T-bar preservation group and 62 in the component reduction group.
Matching covariates: age, gender, ethnicity, previous nasal surgery, trauma, respiratory allergy and preoperative NOSE score.
Outcome tools: NOSE score for blockage, plus FACE-Q and the Utrecht Questionnaire for appearance, assessed before surgery and at 3 and 6 months.
All appearance scores improved significantly in both groups, and did not change between 3 and 6 months.
Breathing favored component reduction at 3 months, but the difference was gone at 6 months.
In the preservation group, only 31 percent needed spreader grafts or autospreader flaps at the internal valve.

What it means for a patient

Both techniques produced similar satisfaction with appearance and breathing by six months.
The preservation technique required extra grafts at the breathing valve in fewer than a third of patients, which spares cartilage.
The early breathing advantage for the conventional technique had disappeared by six months, so the difference appears to be a matter of healing time.
Limits: retrospective, uneven group sizes, follow up only to six months, and matching cannot remove all differences between groups the way randomization would.

Why this paper matters

Preservation techniques are usually promoted on theory and single group series rather than direct comparison. This study is one of the few matched comparisons against a conventional approach, and it finds parity rather than superiority. Longer follow up would be needed to see whether the groups diverge after six months.

Terms

Preservation rhinoplasty: reshaping that keeps native nasal structures intact.
Keystone area: where the nasal bones meet the upper lateral cartilages and septum.
Component reduction: lowering the bridge by trimming its bone and cartilage layers separately.
Spreader graft: a cartilage strip placed alongside the septum to hold the breathing valve open.
Propensity score matching: pairing patients across groups on background characteristics to reduce bias.

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

Abstract

Background: Recently, a modified dorsal split preservation technique has been described. In this method, the integrity of the elastic keystone area is preserved by separation of the upper lateral cartilages from the septal T-bar. Our study aimed to evaluate the aesthetical and functional outcome in patients treated with the dorsal T-bar preservation versus the 'gold' standard dorsal split component reduction approach.

Methods: We performed a retrospective propensity score matched analysis in 234 patients enrolled for rhinoplasty. The severity of nasal obstruction was measured with the nasal obstruction symptom evaluation questionnaire (NOSE score). Aesthetic evaluation was performed with the FACE-Q nose and nostrils and Utrecht Questionnaire (UQ). Assessments were conducted prior to surgery, at 3 and at 6 months after surgery. After propensity score matching, 172 patients in two cohorts were retained. The following covariates were taken into the statistical calculation: age, gender, ethnicity, previous nasal surgery, nasal trauma, respiratory allergy, and preoperative NOSE scores. The first cohort of 110 patients underwent rhinoplasty with T-bar preservation technique (TDP). The control cohort consisted of 62 patients who underwent dorsal split component reduction (SCR).

Results: The mean preoperative scores for FACE-Q nose, FACE-Q nostrils, UQ and VAS score improved significantly in all patients postoperatively. Both techniques had comparable aesthetic outcome measures that remained unchanged between 3 and 6 months postop. Functional outcome as measured by the NOSE score was in favor of SCR at 3 months postop but the difference between both techniques was not significant anymore at 6 months postop. In contrast to SCR, in TDP, only 31% of the patients needed spreader grafts or autospreader flaps at the internal valve area only for functional reasons.

Conclusion: The data in this study suggest similar patient satisfaction with SCR and TDP techniques for aesthetics as well as nasal function after 6 months postop. TDP is a very versatile cartilage-sparing method to aesthetically adapt the middle vault without interrupting the keystone area. It combines the popular component separation concept with the preservation of the delicate anatomy of the mid-vault.

Level Of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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