Scalpel vs Electrocautery for Upper Lateral Cartilage Contouring in Dorsal Preservation Rhinoplasty: A Retrospective Comparative Study

Overview

Dorsal preservation keeps the bridge intact but hump recurrence is a common limitation, particularly after extensive reshaping. Electrocautery, which uses heat, allows precise cartilage contouring but had not been studied in this setting. The authors compared mechanical reshaping with a scalpel against thermal reshaping with monopolar electrocautery on the shoulders of the upper lateral cartilages in low septal strip preservation rhinoplasty.

Sections of note

• Design: retrospective comparative study, 205 patients treated by an open approach, February 2021 to May 2023. Group I: scalpel reshaping, 88 patients. Group II: electrocautery, 117 patients.
• Demographic data, hump shape and the amount of hump reduction were similar between groups.
• Assessment used standardized photographs at 12 months plus the Rhinoplasty Outcome Evaluation questionnaire.
• Hump recurrence: 2.5 percent in the electrocautery group versus 13.6 percent in the scalpel group.
• Satisfaction scores were high and did not differ: 84.4 versus 85.0, p greater than 0.05.
• Stated conclusion: electrocautery offers more consistent contouring and lower recurrence, useful in challenging bridge anatomy.

What it means for a patient

• The hump returning is the recognized failure of preservation rhinoplasty, and this study links it to how the cartilage is reshaped rather than to the technique overall.
• A more than fivefold difference in recurrence is substantial, though satisfaction scores were the same in both groups.
• Heat may work by altering how the cartilage holds its shape rather than only by cutting it, which the abstract does not explore.
• Limits: retrospective, groups not randomized, single practice, and 12 months of follow up when recurrence can develop later.

Why this paper matters

Hump recurrence is the main obstacle to preservation rhinoplasty being adopted more widely, and most proposed solutions concern releasing tension elsewhere. Identifying the reshaping instrument as a factor points somewhere different. A randomized comparison with longer follow up would be needed to act on this confidently.

Terms

• Dorsal preservation rhinoplasty: lowering the bridge while keeping its natural surface intact.
• Upper lateral cartilage: the paired cartilages forming the middle third of the nose.
• Monopolar electrocautery: an instrument using electric current to cut and shape tissue with heat.
• Low septal strip: cartilage removed from the lower septum to let the bridge settle.
• Hump recurrence: the bump on the bridge returning after it was lowered.
• Rhinoplasty Outcome Evaluation: a patient questionnaire scoring satisfaction with the nose.