Shaping the Future of Nasal Surgery: A Systematic Review of Preservation Rhinoplasty

Gucuk D, Knoedler L, Niederegger T, Fenske J, Hundeshagen G, Heiland M, Cetrulo CL, Mathieu O, Schaschinger T, Lellouch AG.

PubMed 42154257 Publisher (DOI)Free full text (PMC)

What this paper says

A systematic review of 13 studies and 855 patients found preservation rhinoplasty gives high satisfaction and 0-7.9% revision rates, with evidence limited by observational designs and short follow-up.

Overview

Following PRISMA 2020, the authors searched PubMed, EMBASE and Web of Science to 1 March 2025 for studies on technique, outcomes, complications and satisfaction in preservation rhinoplasty. Thirteen studies (855 patients, published 2020-2024) were included and summarised narratively because outcome measures varied too much to pool.

Sections of note

Mean Newcastle-Ottawa quality score 5.8 (SD 0.4), indicating moderate quality.
Push-down, let-down and subdorsal strip methods "consistently yielded favorable results."
Rhinoplasty Outcome Evaluation scores above 85 in up to 90.3% of patients.
Nasal patency scores rose and NOSE scores fell across techniques.
Hybrid approaches (mix-down, LUHRS) raised RHINO scores from 37.6 to 88.2 in complex anatomies.
Revision rates ranged from 0 to 7.9%, mostly for minor contour irregularities.

What it means for a patient

Reported satisfaction and breathing outcomes were good in the studies reviewed.
Ideal candidates in these studies had straight profiles, little deviation and intact anatomy; the technique is not for every nose.
Follow-up in the source studies was short, so long-term durability is not established.

Why this paper matters

It is a current, PRISMA-compliant synthesis of preservation outcomes from a German group. Limits stated by the authors: observational data, few standardised objective function tests, short follow-up, no comparative effectiveness conclusion.

Terms

Push-down / let-down: preservation methods that lower the bridge by removing bone at its base (let-down) or impacting it inward (push-down).
Subdorsal strip: removing a strip of septal cartilage just below the bridge so the bridge can drop.
NOSE score: a validated 0-100 breathing-symptom scale; lower is better.
Rhinoplasty Outcome Evaluation (ROE): a six-question satisfaction score out of 100.
Newcastle-Ottawa Scale: a 0-9 quality rating for non-randomised studies.

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

Abstract

Background: Preservation rhinoplasty has transformed nasal surgery by prioritizing structural conservation while achieving aesthetic refinement and functional optimization. Unlike traditional rhinoplasty, which relies on extensive resection and reconstruction, preservation techniques aim to maintain key anatomical components, reducing complications and improving long-term stability. Recent advancements, including open dorsal preservation approaches and hybrid rhinoplasty techniques (bridging preservation and structural concepts), have expanded its indications, making it applicable to a broader range of nasal deformities and functional impairments. However, the efficacy, limitations, and functional outcomes of these techniques remain to be synthesized.

Methods: A systematic review was conducted following PRISMA 2020 guidelines, searching PubMed/MEDLINE, EMBASE, and Web of Science databases up to March 1st, 2025. Studies evaluating surgical techniques, functional and aesthetic outcomes, complications, and patient satisfaction in preservation rhinoplasty were included. Given the heterogeneity of study designs and outcome measures, a narrative synthesis was performed.

Results: Thirteen studies comprising 855 patients were included, with publication years ranging from 2020 to 2024 and a mean Newcastle-Ottawa Scale score of 5.8 (SD 0.4), indicating moderate methodological quality. Dorsal preservation techniques-including push-down, let-down, and subdorsal strip methods-consistently yielded favorable results. Patient satisfaction was high, with Rhinoplasty Outcome Evaluation (ROE) scores exceeding 85 in up to 90.3% of patients. Functional improvement was reported across techniques, with increased nasal patency scores and reduced Nasal Obstruction Symptom Evaluation (NOSE) scores. Hybrid approaches such as mix-down and Low Strip Unifying Hybrid Rhinoseptoplasty (LUHRS) were especially beneficial in complex nasal anatomies, with RHINO scores rising from 37.6 to 88.2. Reported revision rates across all approaches ranged from 0 to 7.9%, typically addressing minor contour irregularities without major complications.

Conclusion: Preservation rhinoplasty has emerged as a potentially promising alternative to traditional structural techniques and may offer favorable dorsal contour preservation, low reported complication rates, and high levels of patient satisfaction in selected patients. Careful patient selection appears to remain essential, with ideal candidates often presenting with straight nasal profiles, minimal dorsal deviation, and relatively intact nasal anatomy. While early outcomes are encouraging, the predominance of observational data, limited use of standardized objective functional assessments, and relatively short follow-up periods restrict definitive conclusions regarding long-term durability and comparative effectiveness. Future research should aim to further refine patient selection criteria, clarify the role of hybrid techniques in more complex cases, and explore the integration of technologies such as 3D imaging and artificial intelligence to potentially enhance surgical planning and outcome assessment in modern nasal surgery.

Level Of Evidence Ii: 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).