Dorsal Preservation versus Open Structural Rhinoplasty: Can We Tell the Difference between Aesthetic and Functional Outcomes?

Overview

Preservation of the bridge, cartilages and skin envelope has re-emerged as a guiding philosophy, valued for keeping the bone and cartilage structure intact and avoiding an open roof. Several studies suggest outcomes comparable to structural rhinoplasty, but how the approaches compare across appearance, function and patient reported measures, and whether surgeons can even tell them apart, was unclear.

Sections of note

• Design: retrospective review comparing dorsal preservation against structural rhinoplasty. Level of evidence therapeutic III.
• Photographs were taken before surgery and one year afterward. 78 participants were included.
• Three types of rater: the general population, plastic surgeons and rhinoplasty surgeons.
• Patients also completed the Rhinoplasty Outcomes Evaluation and SCHNOS questionnaires.
• Across all evaluators, the surgical approach was correctly identified 52.9 percent of the time, barely above chance.
• Rhinoplasty surgeons showed the least variability between raters.
• Mean obstruction composite scores on both questionnaires were comparable between the two groups.
• Stated conclusion: preservation should be performed for appropriate patients given its favorable outcomes.

What it means for a patient

• Neither the public nor experienced surgeons could reliably tell from photographs which approach had been used.
• Breathing and satisfaction scores were similar, so the choice between approaches did not translate into a measurable difference for patients.
• Rhinoplasty specialists agreed with each other more than general plastic surgeons or the public, though they were not more accurate.
• Limits: 78 patients, retrospective, one centre, and one year of follow up, which may be too short for hump recurrence to appear.

Why this paper matters

The preservation versus structural argument assumes the two produce visibly different results, and this study tests that assumption directly by asking whether anyone can tell. Finding chance level identification undercuts claims that either approach has a recognizable signature. It does not address complication or recurrence rates, where the two differ.

Terms

• Dorsal preservation: lowering the bridge while keeping its natural surface intact.
• Structural rhinoplasty: the approach that removes and rebuilds the framework with grafts and sutures.
• Open roof deformity: the flat gap left on top of the nose after a hump is removed.
• Osseocartilaginous construct: the combined bone and cartilage structure of the nose.
• SCHNOS: a validated questionnaire scoring both nasal appearance and nasal blockage.
• Interrater variability: how much different raters disagree with each other.