Preservation Rhinoplasty Versus Structural Rhinoplasty in Dorsal Hump Reduction: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

Overview

No systematic comparison between preservation and conventional structural rhinoplasty for hump correction had been published. The authors searched PubMed, Medline, Embase and Cochrane for randomized trials comparing the two in patients having their hump reduced, assessing both breathing and appearance satisfaction with the SCHNOS questionnaire and visual analogue scales.

Sections of note

• Design: systematic review and meta-analysis restricted to randomized controlled trials.
• Of 38 studies screened, 4 randomized trials with 419 patients met inclusion criteria.
• Preservation showed significant superiority for breathing outcomes: standardized mean difference minus 0.317, 95 percent confidence interval minus 0.509 to minus 0.124.
• Preservation showed significant superiority for appearance outcomes: standardized mean difference minus 0.460, confidence interval minus 0.851 to minus 0.069.
• Breathing outcomes showed low heterogeneity, I squared 0 percent, meaning the trials agreed closely.
• Appearance outcomes showed moderate heterogeneity, I squared 67 percent.
• The abstract reports no complication or hump recurrence rates.

What it means for a patient

• This is the first pooled comparison restricted to randomized trials, which is the strongest design available for this question.
• Both effect sizes are modest. A standardized mean difference of roughly 0.3 to 0.5 is a small to moderate advantage rather than a decisive one.
• The trials agreed closely on breathing but disagreed considerably on appearance, so the appearance finding is less secure.
• Limits: four trials, 419 patients, no reporting of hump recurrence which is the known weakness of preservation, and confidence intervals that come close to zero for appearance.

Why this paper matters

Preservation versus structural rhinoplasty has been argued for a decade largely on single group series and expert opinion. Restricting the pooled analysis to randomized trials raises the evidence level substantially, and it favors preservation on both measures. Complication and recurrence rates, where preservation has historically performed worse, are not addressed.

Terms

• Preservation rhinoplasty: reshaping that keeps native nasal structures intact.
• Structural rhinoplasty: the approach that removes and rebuilds the framework with grafts and sutures.
• SCHNOS: a validated questionnaire scoring both nasal appearance and nasal blockage.
• Standardized mean difference: a measure of effect size comparable across different scales.
• I squared: a measure of how much studies disagree with each other.
• Randomized controlled trial: a study where patients are randomly assigned between treatments.