Comparison of Dorsal Preservation Rhinoplasty and Dorsal Hump Reduction Rhinoplasty: A Systematic Review and Meta-Analysis of Postoperative Outcomes

Khatib M, Skorochod R, Wolf Y.

PubMed 42418006 Publisher (DOI)Free full text (PMC)

What this paper says

Across nine studies and 1,364 patients, preservation and hump-reduction rhinoplasty gave similar results, with preservation showing fewer late complications.

Overview

The authors pooled every published comparison of dorsal preservation (DPR) against conventional hump reduction (DHR). From 257 search hits, nine studies with 1,364 patients qualified. They compared cross-sectional airway measures, the SNOT-22 symptom score, and early and late complications, and graded study quality with Newcastle-Ottawa and Cochrane RoB 2.0 tools.

Sections of note

Patients averaged 30.59 years and 75.22% were female; 56.6% had open and 43.4% closed surgery.
Airway cross-section (MCA1) differed by 0.03 (P = 0.52, not significant); MCA2 differed by 0.03 (P = 0.019), both slightly favouring hump reduction, with the authors calling the significance "questionable."
SNOT-22 differed by -2.88 between groups (P < 0.01).
Early complications: 46 reported, led by tip swelling (18, 39.13%), obstruction (10, 21.74%) and dorsal irregularity (6, 13.04%); pooled odds ratio 0.66, not significant.
Late complications: 128 reported; contour irregularity 53 (41.41%), revision 27 (21.09%), hump recurrence 16 (12.5%), valve collapse 11 (8.59%). Pooled late-complication odds ratio 0.21 favouring preservation (P < 0.01).

What it means for a patient

In this pooled analysis neither technique gave clearly better breathing or shape.
Late complications were less frequent with preservation, but the underlying studies were few and mixed in quality.
Hump recurrence and contour irregularity are the main late problems reported for both methods.
The authors say hump reduction remains appropriate when major structural reshaping is needed.

Why this paper matters

It is the first meta-analysis pooling head-to-head DPR versus DHR data. Limits: only nine studies, high heterogeneity on some measures, and the authors call for trials before drawing firm conclusions.

Terms

Meta-analysis: a statistical pooling of results from several studies.
MCA (minimal cross-sectional area): the narrowest point of the nasal airway, measured by acoustic rhinometry.
SNOT-22: a 22-item questionnaire on sinus and nasal symptoms; lower is better.
Odds ratio (OR): the relative odds of an event in one group versus another; below 1 means fewer events.
Nasal valve collapse: inward buckling of the side wall on inhalation that blocks airflow.

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

Abstract

Background: Rhinoplasty is one of the most popular facial cosmetic procedures. Compared to dorsal hump reduction (DHR), a dorsal "preservation" rhinoplasty (DPR) approach has been developed to reduce the risk of complications and achieve an appealing dorsum.

Methods: An electronic search for articles comparing DHR to DPR was conducted on major databases. Results were screened through title/abstract and full-text stages. Included articles were extracted for information on demographics, surgical and patients reported outcomes, and for safety information. Newcastle-Ottawa scale and Cochrane's RoB 2.0 tool were utilized to assess the risk of bias in included article.

Results: Our search yielded (257) articles, of which nine articles describing a total of 1364 patients were fit for inclusion. The mean age was 30.59 ± 7.27 years, and majority were females (75.22%). Open surgical approach 772 (56.6%) was utilized more than closed approach 592 (43.4%). A mean difference of 0.03 [95% C.I. - 0.06-0.11, p = 0.52] (I2=83.5%, p < 0.01) in postoperative MCA1 was recorded, which was not significant. However, a significant mean difference of 0.03 [95% C.I. 0.01-0.06, p=0.019] (I2=17.4%, p=0.3) in MCA2 was found. Both MCA1 and MCA2 estimates were in favor of DHR, although significance is questionable. SNOT-22 showed a change of -2.88 [95% C.I. - 4.89-0.87, p < 0.01] (I2=0%, p=0.53) between groups. The rate of complications was low. Forty-six incidents of early postoperative complications were reported, with nasal tip edema reported most (n=18, 39.13%) followed by nasal obstruction (n=10, 21.74%) and dorsal irregularity (n=6, 13.04%). Late complications were reported more, and a total of 128 incidents were reported. Contour irregularities occurred in 53 (41.41%) cases. Revisions were needed in 27 (21.09%) patients. Hump recurrence and nasal valve collapse occurred in 16 (12.5%) and 11 (8.59%) patients, respectively. For early complications, three studies were eligible for meta-analysis (OR=0.66 [95% C.I. 0.35-1.25, p=0.2], (I2=0%, p=0.38)). For late surgical complications there was a significant difference in late complication rate, favoring DPR compared to DHR (OR=0.21, [95% C.I. 0.13-0.33, p<0.01]) (I2=0%, p=0.5).

Conclusion: DHR and DPR are comparable in effect, with each offering a promising outcome. DPR has a safety profile comparably beneficial to DHR, while DHR choice is appropriate in cases with substantial structure reshaping. Nevertheless, further research and clinical trials are necessary to establish the benefits of this alternative surgery.

No Level Assigned: 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).