The Process of Single Surgeon Through Structural and Dorsal Preservation in Primary Rhinoplasty: A 594 Case Series with One-Year Follow-Up

Tarragona R, Mirra C.

PubMed 39557639 Publisher (DOI)Free full text (PMC)

What this paper says

Across 594 consecutive first time rhinoplasties by one surgeon, preservation techniques produced fewer contour irregularities but more hump recurrence than the conventional structural approach.

Overview

Managing the bridge is the difficult step in rhinoplasty, and preservation has regained popularity alongside the traditional hump removal described by Joseph. The authors tracked one surgeon's transition from structural to preservation techniques. All 594 consecutive primary rhinoplasties with at least a year of follow up were classified by the approach used to the bridge.

Sections of note

Design: retrospective study of 594 consecutive primary rhinoplasties, single surgeon. Level of evidence IV.
67 men and 527 women, average age 31.43 years.
Three groups: structural dorsal rhinoplasty, partial dorsal preservation and total dorsal preservation.
Average anesthesia times were 231.30, 241.74 and 230.32 minutes respectively, with no significant differences.
Complication rates: structural 12.74 percent, partial preservation 13.37 percent, total preservation 10.57 percent.
Revision rates: structural 7.32 percent, partial preservation 3.82 percent, total preservation 3.25 percent.
Hump recurrence: structural 2.54 percent, partial preservation 7.64 percent, total preservation 6.50 percent.
Contour irregularities: structural 9.55 percent, partial preservation 5.09 percent, total preservation 2.44 percent. Both hump recurrence and contour irregularity differed significantly between groups.

What it means for a patient

The two approaches fail in opposite ways. Conventional hump removal leaves more surface irregularities; preservation lets the hump come back more often.
Total preservation had roughly half the revision rate of the structural approach in this series.
Operating time was essentially the same across all three approaches.
Limits: retrospective, single surgeon, groups formed by era and case selection rather than randomization, so the surgeon's growing experience is entangled with the technique.

Why this paper matters

This is one of the few series comparing both approaches within a single surgeon's practice, which removes differences between operators that confound most comparisons. It quantifies the trade off that the field argues about. Because the approaches were adopted sequentially, the effect of increasing experience cannot be separated from the technique.

Terms

Dorsal preservation: lowering the bridge while keeping its natural surface intact.
Structural rhinoplasty: the approach that removes and rebuilds the bridge with grafts and sutures.
Hump recurrence: the bump on the bridge returning after it was lowered.
Contour irregularity: a visible or palpable bump, dip or edge on the surface of the nose.
Revision rate: the proportion of patients needing a further operation.
Primary rhinoplasty: a first nose operation, with no previous nasal surgery.

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

Abstract

Background: Dorsal management is a challenging step in rhinosurgery. In the last decade, an old philosophy of preserving the dorsum has gained popularity alongside the traditional hump resection proposed by Joseph. This study aims to investigate the journey of a rhinosurgeon transitioning from structural to dorsal preservation techniques in primary rhinoplasty.

Methods: A retrospective study was conducted on 594 consecutive patients who underwent primary rhinoplasty by the main surgeon (R.T.) with at least 12 months of follow-up. All surgeries were categorized based on the dorsal approach into Structural Dorsal Rhinoplasty (SDR), Partial Dorsal Preservation Rhinoplasty (PDPR), and Total Dorsal Preservation Rhinoplasty (TDPR). The three groups were compared based on the following variables: operative time, long-term complication rate, and re-intervention rate.

Results: The study included 67 males and 527 females, with an average age of 31.43 years. The average anesthesia operative times were 231.30 minutes for SDR, 241.74 minutes for PDP, and 230.32 minutes for TDP, with no statistically significant differences observed. The complication and revision rates were as follows: SDR had 12.74% complications and 7.32% revisions, PDPR had 13.37% complications and 3.82% revisions, and TDPR had 10.57% complications and 3.25% revisions. Hump recurrence rates were 2.54% in SDR, 7.64% in PDPR, and 6.50% in TDPR. Contour irregularities occurred in 9.55% of SDR, 5.09% of PDPR, and 2.44% of TDPR cases. Both hump recurrence and contour irregularities showed statistically significant differences among the three groups.

Conclusion: This study analyzed how the aforementioned variables change during the transition from structural to dorsal preservation techniques, considering the latter as the natural evolution in rhinoplasty.

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).