The Ballerina Maneuver: A Lateral Keystone Release Technique in Preservation Rhinoplasty

Overview

Preservation rhinoplasty lowers the bridge as a unit, which can leave a straight profile when the patient wants a gentle concavity, especially in low-to-moderate humps. This is a technical description, not an outcome study. The maneuver modifies the middle vault in a controlled way while keeping the dorsum continuous, and is illustrated with representative cases.

Sections of note

• Study design: technical description of a surgical maneuver with representative clinical cases.
• The maneuver is an adjunct step performed in selected patients who want a more concave profile.
• It works by releasing the lateral keystone so the osseocartilaginous vault can be repositioned caudally.
• Reported effect in the cases shown: a smoother, more concave dorsal contour with the native dorsum intact.
• No patient numbers, follow-up or complication rates are given in the abstract.

What it means for a patient

• Preservation surgery can be adjusted to produce a slightly scooped profile rather than only a straight one.
• The evidence here is illustrative cases from the technique's developers, not measured outcomes.
• Whether the effect holds long term is not addressed.

Why this paper matters

It comes from two of the surgeons who defined modern dorsal preservation and adds a named, reproducible step to the method. Limits: no data, no controls, no follow-up stated.

Terms

• Lateral keystone: the side junction between the nasal bones and the upper lateral cartilages.
• Osseocartilaginous vault: the bone-and-cartilage roof of the nose.
• Caudal repositioning: moving a structure downward, toward the tip.
• Dorsal concavity: a gentle inward curve of the bridge on profile.