Open Structural Versus Dorsal Preservation Rhinoplasty: A Comparative Survey Study of Aesthetic Outcomes

Ganesh Kumar N, Fisher SM, Rifkin W, Borab Z, Sherif R, Rohrich RJ.

PubMed 40770501 Publisher (DOI)Free full text (PMC)

What this paper says

Fifty-one expert rhinoplasty surgeons shown result photographs could not reliably tell which noses had been done by preservation and which by open structural technique.

Overview

Rohrich's group asked whether experts can see a difference between open structural rhinoplasty (OSR) and dorsal preservation rhinoplasty (DPR). They built a survey of cases with 2.5-month and 1-year follow-up photographs and sent it to Rhinoplasty Society members and Dallas Rhinoplasty instructors. Respondents guessed the technique; scores were near chance.

Sections of note

51 surgeons responded (24.2% response rate), averaging almost 10 years of experience and 58 rhinoplasties per year.
59% used open techniques, 39% used both open and closed, 54.5% used preservation techniques.
Average correct identification: 58% at 2.5 months and 61% at 1 year.
No correlation between accuracy and case volume, years of experience, comfort level or personal use of preservation.
Level of Evidence V.

What it means for a patient

In this survey, experienced surgeons could not see a consistent visual difference between the two approaches at one year.
Marketing claims that one technique gives visibly better results are not supported here.
The authors suggest both techniques can be used, and combined, case by case.

Why this paper matters

It comes from the Dallas structural-rhinoplasty tradition and tests the visual claims of the preservation movement directly. Limits: survey-based, photographs only, low response rate, and no measurement of function or complications.

Terms

Open structural rhinoplasty (OSR): surgery through a small columellar incision, lifting the skin to rebuild the framework with grafts.
Dorsal preservation rhinoplasty (DPR): lowering the intact bridge instead of removing the hump.
Rhinoplasty Society: a US society of surgeons who focus on rhinoplasty.
Dallas Rhinoplasty: the annual Dallas symposium and its faculty, a centre of structural teaching.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Introduction: Dorsal preservation rhinoplasty (DPR) is increasingly popular, with some suggesting superior outcomes over open structural rhinoplasty (OSR). To date, there has been little investigation into comparative outcomes between the techniques. This study aims to ascertain whether experts in the field can differentiate between the techniques in aesthetic outcomes.

Methods: A survey was created that consisted of OSR and DPR cases with an average 2.5 month and 1 year follow-up. The survey was distributed to the Rhinoplasty Society and Dallas Rhinoplasty instructors. Results were correlated to expertise in rhinoplasty. Univariate analysis was performed using Chi-square or Fischer's exact test for categorical variables and Student's t-test for continuous variables. Pearson's correlation coefficient was used to assess the relationship between study variables. Statistical significance was defined as p < 0.05.

Results: Fifty-one plastic surgeons responded (24.2 % response rate). Participants averaged almost 10 years of experience, with an average 58 rhinoplasties performed annually. 59% used open techniques and 39% used both open and closed. 54.5% utilized preservation techniques. The average correct survey score was 58% at 2.5 months and 61% at 1 year. There was no positive correlation between survey score and rhinoplasties performed, experience in years, comfort level or utilization of preservation rhinoplasty techniques.

Conclusions: The study demonstrates no discernable differences in aesthetic results when using OSR and DPR techniques at 1 year after surgery. Ultimately, OSR and DPR techniques should both be considered and potentially combined, when performing rhinoplasty.

Level Of Evidence V: 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).