Aspects and Concepts of What I Preserve in Rhinoplasty: Proceedings of the 2025 American Society of Plastic Surgeons Spring Meeting

Overview

The authors note that national rhinoplasty rates are rising while plastic surgeons' share of those procedures may be shifting, and that rhinoplasty remains among the hardest procedures to teach residents. They attribute lower adoption partly to the number of competing approaches and emerging philosophies. Whether structural or preservation techniques give better long term results is described as operator dependent.

Sections of note

• Article type: proceedings of a conference session. No patient numbers or outcome data are reported.
• Four senior rhinoplasty surgeons contributed, representing 115 combined practice years.
• Stated context: rhinoplasty rates are rising nationally while plastic surgeons' share may be changing.
• Stated problem: rhinoplasty is among the most difficult procedures to teach residents.
• Stated position: whether structural or preservation achieves superior long term outcomes remains operator dependent.
• Topics discussed: selective use of structural versus preservation techniques, techniques and graft choices for three dimensional nasal anatomy, aligning surgeon and patient goals before surgery, and teachability to trainees.
• Stated output: a framework for selectively introducing preservation principles into a modern approach.

What it means for a patient

• Experienced surgeons do not agree on which approach is better, and the panel's own position is that the result depends on who is operating.
• Preservation principles are described as being introduced selectively into a broader approach rather than adopted wholesale.
• Aligning goals before surgery is listed alongside technique, reflecting that mismatched expectations cause dissatisfaction independently of the operation.
• The abstract carries no findings. It reports no outcomes, rates or comparisons.

Why this paper matters

The preservation debate is being settled through practice and expert consensus rather than trials, and meeting proceedings record where that consensus currently sits. Teachability appears as a criterion alongside outcomes, which is unusual and reflects a stated workforce concern. No evidence is presented on either side of the technique question.

Terms

• Preservation rhinoplasty: reshaping that keeps native nasal structures intact.
• Structural rhinoplasty: the approach that divides and rebuilds the framework with grafts and sutures.
• Operator dependent: an outcome determined more by who performs the procedure than by the technique.
• Graft choice: the decision about which material and shape of graft to use.
• Functional nasal anatomy: the structures that determine how well the nose moves air.