Preservation Rhinoplasty by the Ones Who Do It: A Worldwide Survey

Overview

Dorsal preservation splits into two families: surface techniques, which reshape the bridge from above, and foundation techniques, which lower the whole structure from below. The authors surveyed 117 surgeons drawn from an online Evidence-Based Rhinoplasty Research Group, spanning a range of geography, experience and training, to capture how the techniques are actually used and viewed.

Sections of note

• Design: opinion and practice survey of 117 surgeons who use dorsal preservation.
• Surface techniques were most used for the bone changes, and the high-strip technique was preferred for the cartilage septum.
• Surface techniques were mostly performed by surgeons with under 10 years of experience.
• Foundation techniques were more common among surgeons with 10 to 30 years of experience.
• Surface techniques were rated more stable, p less than 0.001, more predictable, p less than 0.001, and associated with a shorter learning curve, p equal to 0.015.
• Revision surgery rates did not differ between the two approaches.
• The most cited reason surgeons using preservation still perform structural rhinoplasty was persistence or recurrence of the hump.
• Most respondents use dorsal preservation in over half of their primary rhinoplasties.

What it means for a patient

• Among surgeons who have adopted preservation, it is not an occasional technique. Most use it in the majority of first time operations.
• The two families divide by generation, with newer surgeons favoring surface techniques.
• Hump recurrence is the acknowledged reason preservation surgeons still fall back on the conventional structural approach in some cases.
• Limits: this records what surgeons believe and report doing, not measured outcomes, and respondents were self selected from a research interest group.

Why this paper matters

Preservation rhinoplasty is spreading faster than comparative evidence, so how practitioners actually use it is itself informative. The finding that perceived stability differs while reported revision rates do not points to a gap between belief and outcome. Whether surface techniques genuinely perform better remains unmeasured.

Terms

• Dorsal preservation: lowering the bridge while keeping its natural surface intact.
• Surface technique: reshaping the bridge from above while keeping its outer surface.
• Foundation technique: lowering the entire bony bridge from beneath, as in push-down or let-down.
• High-strip technique: removing a strip of septal cartilage high beneath the bridge.
• Structural rhinoplasty: the approach that divides and rebuilds the framework with grafts.
• Learning curve: how much practice a technique requires to perform reliably.