Narrowing the Nasal Roof with Paramedial Osteotomy in Preservation Rhinoplasty

Ozturk G.

PubMed 39191923 Publisher (DOI)Free full text (PMC)

What this paper says

In 68 patients with both a hump and a wide nasal roof, combining preservation techniques with a paramedial bone cut raised median satisfaction scores from 48.5 to 91.5 at one year.

Overview

Preservation rhinoplasty lowers the hump but does not narrow the bridge, so patients with both a hump and a wide nasal roof are poorly served by it. The authors combined push-down or let-down methods with a paramedial osteotomy, a bone cut placed beside the midline, to address both problems in one operation. Patients were reviewed retrospectively and assessed with a validated questionnaire.

Sections of note

Design: retrospective review, 68 patients: 51 women and 17 men. Level of evidence IV.
Inclusion required both a nasal hump deformity and a wide nasal roof.
Assessment used the Rhinoplasty Outcome Evaluation questionnaire before surgery and one year afterward.
Follow up ranged from 12 to 24 months.
Median score rose from 48.5 before surgery to 91.5 afterward, p less than 0.001.
Satisfaction was described as remarkable in 97.3 percent of cases.
The abstract does not report complication rates or hump recurrence.
Stated conclusion: surgeons experienced in push-down or let-down can apply this combination for wide nasal roofs.

What it means for a patient

Preservation techniques address height but not width, and this combination adds a bone cut to narrow the roof.
Satisfaction scores roughly doubled and 97.3 percent were described as satisfied.
The abstract does not report whether the hump came back, which is the main complication of preservation techniques.
Limits: 68 patients, retrospective, single surgeon, no comparison group, and no complication data reported.

Why this paper matters

The two main limitations of preservation rhinoplasty are hump recurrence and an unchanged wide bridge, and the second has fewer proposed solutions. Adding a paramedial bone cut extends the technique to a group previously excluded. Whether the added cut affects stability or recurrence is not reported here.

Terms

Preservation rhinoplasty: reshaping that keeps native nasal structures intact.
Nasal roof: the upper surface of the bony bridge between the two nasal bones.
Paramedial osteotomy: a bone cut placed just beside the midline of the nose.
Push-down and let-down: lowering the bridge by sinking it or by removing a bone wedge first.
Dorsal hump: the bump of bone and cartilage on the bridge of the nose.
Rhinoplasty Outcome Evaluation: a patient questionnaire scoring satisfaction with the nose.

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

Abstract

Introduction: Rhinoplasty is frequently performed in aesthetic and plastic surgery, with hump deformity being common in Western populations. Osteotomies play a crucial role in managing this, especially for dorsal hump reduction in closed rhinoplasty.

Objectives: Despite advancements, treatments for simultaneous nasal hump deformity and wide nasal roof are inadequate in preservation rhinoplasty. This study introduces a technique merging push-down and let-down methods with paramedial osteotomy for these cases.

Methods: A retrospective review was conducted on patients undergoing push-down or let-down rhinoplasty, identifying 68 individuals (51 females and 17 males) with both nasal hump deformity and wide nasal roof. They were evaluated using the Rhinoplasty Outcome Evaluation questionnaire before surgery and 1-year post-operation.

Results: Follow-up ranged from 12 to 24 months, with significant improvement in patient satisfaction. The median Rhinoplasty Outcome Evaluation score rose from 48.5 pre-surgery to 91.5 post-surgery (p < 0.001), indicating remarkable patient satisfaction in 97.3% of cases.

Conclusion: This research is to demonstrate narrowing the nasal roof in patients who had nasal hump deformity and wide nasal roof with a combination of dorsal preservation techniques and osteotomy. Surgeons experienced in push-down or let-down techniques can apply this combination technique to obtain better aesthetic outcomes in patients with a wide nasal roof.

Level Of Evidence Iv: 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).