Clarification and Classification of Dorsal Preservation Rhinoplasty: Lessons from a Continuous 1,191-Case Experience

Saban Y, Sachanandani NS.

What this paper says

Over 1,191 consecutive primary rhinoplasties by Yves Saban from 2010 to 2024, revision rates went from 3.4% to 9.9% to 3.3% as indications were first tested, then over-expanded, then consolidated into a classification system.

Overview

Saban is the surgeon most associated with modern dorsal preservation. He and Sachanandani reviewed his 1,191 consecutive primary cases in three periods: 2010-2014 (n = 320) introducing push-down and let-down in selected cases; 2015-2019 (n = 352) expanding to complex noses; 2020-2024 (n = 519) applying a unified framework. Revision rates were compared.

Sections of note

Series 1: 11 revisions (3.4%), showing feasibility in favourable cases.
Series 2: 35 revisions (9.9%) during "uncontrolled expansion of indications."
Series 3: 17 revisions (3.3%) after refined patient selection and decision-making.
The difference across series was significant (chi-squared 21.61, p < 0.001).
The third series produced a pyramidal classification with named septoplasty "modulators" and W-point septoplasty.

What it means for a patient

Even the originator's revision rate tripled when preservation was applied to noses it did not suit, then fell back once selection rules were set.
Around 1 in 30 patients needed revision in the mature series.
A surgeon's case selection matters as much as the technique.

Why this paper matters

It is the largest single-surgeon preservation series and openly documents a learning curve, with a proposed unified terminology. Limits: retrospective, single surgeon, revision as the only outcome reported in the abstract.

Terms

Push-down / let-down: preservation osteotomy methods that lower the bony vault by impaction or by removing a strip of bone at its base.
Pyramidal classification: the authors' scheme grouping noses by how the bony-cartilaginous pyramid should be handled.
Septoplasty modulator: a named septal manoeuvre that controls how far and where the dorsum drops.
W-point: the junction on the septum where the upper lateral cartilages diverge, used as a landmark for septal cuts.
U-shaped learning curve: outcomes worsen before improving as a technique matures.

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

From the abstract

“Dorsal preservation rhinoplasty (DPR) has attracted significant attention in recent years. However, the rapid dissemination of diverse techniques and terminology has generated confusion regarding definition, indications, methodology, and outcomes. A unified conceptual framework remains lacking. Methods: We…”

Excerpt; the full abstract is on PubMed.