Dorsal Preservation Rhinoplasty: The Perspective of "Preservers" vs. "Structured" Surgeons

Overview

The authors set out to describe which surgeons have adopted dorsal preservation and how they use it. An anonymous form, reviewed by the board of the Evidence-Based Rhinoplasty Research Group, was shared on the group's Telegram channel. Respondents were sorted into three groups by their answers: Preservers, Mainly Structural, and Structural exclusively.

Sections of note

• Design: anonymous survey of 145 surgeons worldwide, self selected from a research interest group.
• Preservation was more common among plastic surgeons than among otolaryngologists and facial plastic surgeons.
• Preservation techniques were preferred by surgeons with 10 to 20 years of experience; structural techniques by those with over 20 years.
• 50.8 percent of surgeons preferring preservation use it in more than 90 percent of first time operations.
• Surface techniques have been used more, mainly by surgeons who prefer structural techniques, p less than 0.001.
• Surface techniques were considered more stable, more predictable and to have a shorter learning curve, all p less than 0.001.
• Many surgeons using preservation still perform structural rhinoplasty, most often citing hump persistence or recurrence.

What it means for a patient

• Whether you are offered preservation depends partly on your surgeon's specialty and how long they have practised.
• Among surgeons who adopt it, half use it in nearly every first time operation, so it is a default rather than an occasional choice for them.
• Hump recurrence is the acknowledged reason preservation surgeons keep the structural approach available.
• Limits: this records opinion and reported practice, not measured outcomes, and respondents were self selected from an online group with a stated interest in the topic.

Why this paper matters

Preservation rhinoplasty is spreading faster than comparative evidence, so how surgeons actually use it and why they hesitate is informative in itself. The stated perceptions of stability and predictability are beliefs, not measurements. Whether those beliefs match outcomes is unresolved.

Terms

• Dorsal preservation: lowering the bridge while keeping its natural surface intact.
• Structural rhinoplasty: the approach that divides and rebuilds the framework with grafts and sutures.
• Surface technique: reshaping the bridge from above while keeping its outer surface.
• Hump recurrence: the bump on the bridge returning after it was lowered.
• Learning curve: how much practice a technique requires to perform reliably.
• Otolaryngologist: an ear, nose and throat surgeon.