Middle Vault Dorsal Augmentation in Rhinoplasty as "Push-up" Preservation Technique or as "Modified Dorsal Split Extended Push-up" Procedure

Szychta P, Robotti E.

PubMed 39174803 Publisher (DOI)Free full text (PMC)

What this paper says

In 12 patients with saddle nose deformity, raising the middle of the bridge from beneath rather than adding rib cartilage on top improved breathing scores and left no palpable irregularities.

Overview

Augmenting a collapsed or under-projected bridge is usually done with rib cartilage grafts, which can leave palpable irregularities and add donor site problems. The authors applied preservation principles instead, pushing the existing structure up rather than building on it. Twelve patients with saddle nose and significant breathing impairment were treated with either the push-up technique or a modified extended variant.

Sections of note

Design: case series of 12 patients. Level of evidence III.
8 patients had the push-up technique; 4 required the dorsal split extended push-up due to extensive scarring and mucosal adhesions from previous surgery.
Breathing was assessed with the NOSE scale before surgery and at three months, improving significantly in all patients, p less than 0.05.
Aesthetic outcome was described as a naturally augmented smooth bridge with no palpable irregularities.
Satisfaction was rated 9 or 10 out of 10 by 10 patients and 7 or 8 by 2 patients.
Follow up was 6 months.

What it means for a patient

A saddle nose is a collapsed bridge, and the usual fix is a cartilage graft laid on top, which can be felt or seen through the skin.
Raising the existing structure avoids adding a graft to the bridge, so there is nothing on the surface to become palpable.
A third of patients needed the extended variant because scarring from earlier surgery prevented the simpler version.
Limits: 12 patients, no comparison group, breathing measured at three months and follow up only to six months, with satisfaction on a single unvalidated rating.

Why this paper matters

Bridge augmentation with rib is the standard answer to a collapsed bridge and carries the recognized costs of visible edges and a chest incision. Applying preservation logic in the opposite direction, lifting rather than lowering, is a genuinely different approach. Twelve patients with six months of follow up establishes feasibility only.

Terms

Saddle nose deformity: a collapsed bridge that dips in the middle.
Middle vault: the middle third of the nose, formed by the upper lateral cartilages and septum.
Dorsal augmentation: adding height to the bridge of the nose.
Push-up technique: raising the existing bridge structure rather than adding a graft on top.
Costal cartilage: cartilage from the ribs, harvested for use as a graft.
NOSE scale: a questionnaire measuring nasal blockage, where higher means worse.

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

Abstract

Background: Primary or secondary dorsal augmentation rhinoplasty addresses aesthetic and functional issues related to a deficient, under-projected, or depressed nasal dorsum, frequently in middle vault. Traditional treatments often involve costal cartilage grafts, which can result in palpable irregularities and additional morbidity. Implementing dorsal preservation techniques in selected patients may improve predictability and outcomes of dorsal augmentation.

Materials And Methods: We conducted a case series involving 12 patients with saddle nose deformities and significant nasal function impairment. All patients underwent either "push-up" preservation technique or "modified dorsal split extended push-up" technique. The techniques were evaluated for feasibility, safety, and efficacy. Functional outcomes were assessed using the nasal obstruction symptom evaluation (NOSE) scale preoperatively and three months postoperatively.

Results: Eight patients underwent "push-up" technique, and four patients required "dorsal split extended push-up" technique due to extensive scarring and mucosal adhesions from previous surgeries. All patients demonstrated significant postoperative improvement in nasal function as indicated by a reduction in NOSE scores (p < 0.05). Aesthetic outcomes showed a naturally augmented and smooth dorsum with no palpable irregularities. Patient satisfaction was rated very high (9 or 10 out of 10) in 10 patients and high (7 or 8 out of 10) in 2 patients. Follow-up was 6 months.

Conclusion: "Push-up" preservation technique and its extended variant provide a new surgical alternative for primary and secondary rhinoplasty with costal cartilage. These techniques offer improved and highly predictable aesthetic outcomes of the nasal dorsum with decreased morbidity, demonstrating significant potential for clinical practice and future research.

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).