Comparison of Functional and Cosmetic Outcomes Between Dorsal Preservation and Spreader Flap Rhinoplasty: A Randomized Trial

Zarei R, Most SP, Amali A, Saedi B.

PubMed 38366551 Publisher (DOI)

What this paper says

In a randomised trial of 84 patients, dorsal preservation with a modified subdorsal strip and conventional hump resection with spreader flaps gave the same results at one year for residual hump, width, projection, rotation, satisfaction and SCHNOS scores.

Overview

This Tehran trial (with Stanford's Most as co-author) is one of the few randomised comparisons of preservation versus conventional hump reduction. Eighty-four rhinoplasty candidates were randomly assigned to hump resection with spreader-flap mid-vault reconstruction or to dorsal preservation with the modified subdorsal strip method. At one year, outcomes were assessed with SCHNOS, VAS and image analysis.

Sections of note

84 patients; mean age 30.96 (SD 6.75); 15 (17.6%) male; groups balanced on confounders.
Residual hump: no difference (P = .11).
Nasal width P = .37; projection P = .70; rotation P = .79.
VAS P = .81; SCHNOS P = .90.
Conclusion: outcomes "may be comparable."

What it means for a patient

In the best-designed comparison available, neither technique gave better appearance or breathing at one year.
Claims that preservation produces superior results are not supported by this trial.
One year is short for judging hump recurrence, which can appear later.

Why this paper matters

It is a randomised trial in a field dominated by retrospective series, and it found equivalence. Limits: 84 patients, one-year follow-up, single centre, one variant of each technique.

Terms

Randomised trial: patients assigned to treatments by chance to make groups comparable.
Subdorsal strip: a strip of septal cartilage removed just below the bridge so the intact dorsum can drop.
Spreader flap: the upper lateral cartilage folded inward to rebuild the middle vault after hump removal.
Residual hump: a bump remaining after surgery.
SCHNOS: a validated nasal outcome questionnaire.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Preservation rhinoplasty is a novel and increasingly utilized method in nasal plastic surgery. Objectives: The study aimed to compare the functional and aesthetic outcomes of dorsal preservation rhinoplasty, a new and interesting method, with conventional hump resection. Methods: A total of 84 rhinoplasty applicants…”

Excerpt; the full abstract is on PubMed.