Safe and Integrated Practices in Rhinoplasty: A Contemporary Perspective on Function, Aesthetics, and Patient Safety

Capuchinho-Júnior GA, Cervantes A, Nikoumaram B, Robotti E, Hesamirostami M, Çerkes N, Poignonec S.

PubMed 42581097 Publisher (DOI)Free full text (PMC)

What this paper says

A review from members of the ISAPS Patient Safety Committee of 2019-2025 literature, finding a global shift from reductive to structural and preservation techniques and calling for standardised perioperative workflows, psychological screening and validated outcome measures rather than standardised operative technique.

Overview

This is a perspective review by an international author group including Robotti and Cerkes. They examined systematic reviews, meta-analyses and ISAPS documents on functional, structural and preservation rhinoplasty across pre-, intra- and postoperative phases, looking for associations with safety and satisfaction. No patient data are presented; the article is explicitly not an official ISAPS guideline.

Sections of note

Observed global shift from reductive to structural and preservation approaches prioritising anatomy and function.
Evidence supports team planning, psychological screening and standardised protocols across the operative pathway.
Technology has improved predictability and training.
Substantial variability in techniques persists; the authors argue for standardising workflows, documentation and outcome assessment, not the operation itself.
Level of Evidence V.

What it means for a patient

Leading international bodies now frame rhinoplasty safety as a system: screening, planning, documented protocols and measured outcomes.
The surgeon is cast as "a technical and ethical mediator," responsible for expectations as well as technique.
This is a position statement, not a set of rules.

Why this paper matters

It reflects current consensus thinking from a global society's safety committee. Limits: opinion, no new data, not a formal guideline.

Terms

ISAPS: International Society of Aesthetic Plastic Surgery.
Reductive rhinoplasty: the older approach of removing tissue without adding support.
Structural / preservation rhinoplasty: the two modern philosophies of rebuilding or keeping support.
Validated outcome assessment: measuring results with tested questionnaires.
Nonmaleficence: the ethical duty to avoid harm.

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

Abstract

Objective: To present an integrated, evidence-based view of current rhinoplasty practices, emphasizing patient safety, functional preservation, and interdisciplinary collaboration.

Methods: We reviewed the literature published between 2019 and 2025, including systematic reviews, meta-analyses, and official documents from the International Society of Aesthetic Plastic Surgery (ISAPS) covering functional, structural, and preservation approaches. Studies regarding the pre-, intra-, and postoperative phases were analyzed to identify associations with patient safety and satisfaction.

Results: A global shift from reductive techniques to structural and preservation approaches prioritizing anatomical respect and functional integrity was observed. Evidence supports team planning, psychological screening, and standardized protocols applied across the operative pathway to reduce complications. In addition, technological advances have improved predictability and surgical training. Despite advances, substantial variability in techniques and protocols persists, underscoring the need to strengthen a shared culture of safety through standardized perioperative workflows, structured documentation, and validated outcome assessment, rather than standardizing operative techniques.

Conclusions: Rhinoplasty should combine esthetic precision with preservation of nasal function and ethical responsibility. Establishing a global culture of safety requires more than protocols; it demands empathy, collaboration, and the surgeon's active role as a technical and ethical mediator at all stages of care. While not an official ISAPS guideline, this article offers a critical reflection on current evidence and discussions within the ISAPS Patient Safety Committee.

Level Of Evidence V: 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).