Combination of Paramedian Dorsal Component Excision and Low Septal Strip Septoplasty: A Hybrid Rhinoplasty Technique with Endonasal Approach

Çelik V, Parspancı A, Tuluy Y.

PubMed 40855022 Publisher (DOI)Free full text (PMC)

What this paper says

In 94 closed primary rhinoplasties combining a low septal strip with removal of the side components of the hump while keeping the keystone, complications occurred in 6.38% and all six were revised.

Overview

Dorsal preservation can leave residual or recurrent humps and irregularities. The authors combined two approaches: a low septal strip (a preservation manoeuvre that lets the dorsum drop) with paramedian excision of the dorsal components (a structural step) while keeping the central keystone intact. They retrospectively reviewed 94 primary endonasal cases from January 2023 to March 2024 for demographics, complications and revisions.

Sections of note

65 women and 29 men; mean age 32.30 (SD 9.55), range 18-57.
Mean follow-up 10.08 months (range 6-15).
Complications in 6 of 94 (6.38%), all revised: tip drooping in 3, dorsal irregularity in 2, nasal deviation in 1.
All cases were closed-approach primary rhinoplasty.
Level of Evidence III.

What it means for a patient

This is a "hybrid" that keeps the central bridge but removes the sides of the hump, aimed at cleaner dorsal lines and less recurrence.
The revision rate of about 1 in 16 within the first year is the key figure; no patient-reported scores are given.
Tip drooping was the commonest reason for revision, not the hump itself.

Why this paper matters

It adds to the growing family of hybrid preservation-structural techniques, with a concrete complication count. Limits: retrospective, single group, short follow-up, no patient-reported outcomes or comparison arm.

Terms

Low septal strip: removal of a strip of cartilage at the base of the septum so the whole dorsum can be lowered.
Paramedian: beside the midline.
Keystone area: the central junction of nasal bones, upper lateral cartilages and septum.
Endonasal: performed through incisions inside the nose.

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

Abstract

Background: In dorsal preservation techniques of rhinoplasty, problems such as residual and recurrent hump and dorsal irregularities are encountered. In this study, we combined paramedian dorsal component excision with low septal strip septoplasty by preserving the keystone area. The clinical results of this combination on the dorsum were evaluated.

Patient And Methods: Ninety-four patients who underwent hybrid rhinoplasty technique with paramedian dorsal component excision and low septal strip septoplasty combination between January 2023 and March 2024 were included in the study. All cases were primary rhinoplasty, and endonasal approach was performed in all cases. Patient demographics, complications, revision surgeries and follow-up were analyzed retrospectively.

Results: A total of 65 female and 29 male patients were included in the study. The mean age of the patients is 32.30±9.55 years (18-57). The mean follow-up period was 10.08 ± 2.78 months (6-15 months). Complications were observed in 6.38% of the patients (n = 6/94). All these patients underwent revision surgery. Revision surgeries were performed for tip drooping in three patients, dorsal irregularities in two patients and nasal deviation in one patient.

Conclusions: Providing ideal dorsal aesthetic lines with hump treatment is one of the most important parts of dorsal preservation rhinoplasty techniques. Our hybrid technique, which combines a low septal strip with paramedian dorsal component excision, can effectively reduce hump recurrence and achieve ideal dorsal aesthetic lines.

Level Of Evidence Iii: 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).