Abstract
Background
There has recently been a resurgence of interest in preservation rhinoplasty (PR) for dorsal hump elimination or dorsal projection reduction. However, no studies have scrutinized aesthetic outcomes to identify common pattern of flaws seen in published images to aid those with ardent enthusiasm for this technique to become aware of the frequency of these flaws and find ways to reduce imperfections.
Methods
A systematic literature review was performed using search terms (“preservation” OR “let down”, “push down”) AND “rhinoplasty” on PubMed, Cochrane, SCOPUS, and EMBASE databases for studies between January 2000 and December 2022. Patient images from these studies were analyzed by three reviewers (MWW, IAC, and BG) for dorsal flaws. Raw interrater agreement percentage and Krippendorff’s alpha were calculated to determine interrater reliability. A descriptive and comparative analysis with Fisher’s exact test was performed for the aggregate data.
Results
There were 59 patient images with 464 views from 24 studies included for final analysis. Optimal dorsal aesthetic lines (DAL) were noted in 12 patients (20.3%), while optimal profile was observed in 15 patients (25.4%) (p = 0.66). Combined ideal front and profile view of dorsum was not observed on any patients. The most common flaws were DAL irregularities (n = 45; 78.0%), dorsal deviation (n = 32, 54.2%), and residual hump (n = 25, 42.4%). There was excellent interrater agreement.
Conclusions
While PR may have some advantages, it has shortcomings in outcomes, particularly dorsal irregularities, dorsal deviation, and residual humps. Awareness of these imperfections may compel those performing this procedure to modify their techniques and improve their results.
Level of Evidence III
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.
Similar content being viewed by others
References
Daniel RK (2018) The preservation rhinoplasty: a new rhinoplasty revolution. Aesthet Surg J 38(2):228–229. https://doi.org/10.1093/asj/sjx258
Daniel RK, Kosins AM (2020) Current trends in preservation rhinoplasty. Aesthet Surg J Open Forum 2(1):ojaa003. https://doi.org/10.1093/asjof/ojaa003
Neves JC, Arancibia-Tagle D (2021) Avoiding aesthetic drawbacks and stigmata in dorsal line preservation rhinoplasty. Facial Plast Surg 37(1):65–75. https://doi.org/10.1055/s-0041-1725101
Krippendorff K (1970) Estimating the reliability, systematic error and random error of interval data. Educ Psychol Measur 30(1):61–70. https://doi.org/10.1177/001316447003000105
Chang IA, Wells MW, Chang IA et al (2022) The positive patient experience: a comprehensive analysis of plastic surgery online reviews. Aesthet Surg J 42(9):1083–1093. https://doi.org/10.1093/asj/sjac092
Öztürk G (2021) Semi-let-down and semi-push-down preservation techniques: maintaining the intactness of the distal region. Aesthet Surg J 41(6):Np267-np280. https://doi.org/10.1093/asj/sjaa436
Neves JC, ArancibiaTagle D, Dewes W, Larrabee W (2020) The split preservation rhinoplasty: “the Vitruvian Man split maneuver.” Eur J Plast Surg 43(3):323–333. https://doi.org/10.1007/s00238-019-01600-3
Öztürk G (2021) Combination of the push-down and let-down techniques: mix-down approaches. Aesthet Plast Surg 45(3):1140–1149. https://doi.org/10.1007/s00266-020-02012-6
Patel PN, Abdelwahab M, Most SP (2021) Combined functional and preservation rhinoplasty. Facial Plast Surg Clin North Am 29(1):113–121. https://doi.org/10.1016/j.fsc.2020.09.005
Öztürk G (2021) Prevention of nasal deviation related to preservation rhinoplasty in non-deviated noses using suturing approaches. Aesthet Plast Surg 45(4):1693–1702. https://doi.org/10.1007/s00266-020-02105-2
Tuncel U, Aydogdu IO, Kurt A (2021) Reducing dorsal hump recurrence following push down-let down rhinoplasty. Aesthet Surg J 41(4):428–437. https://doi.org/10.1093/asj/sjaa145
Tuncel U, Aydogdu O (2019) The probable reasons for dorsal hump problems following let-down/push-down rhinoplasty and solution proposals. Plast Reconstr Surg 144(3):378e–385e. https://doi.org/10.1097/prs.0000000000005909
Öztürk G (2021) Push down technique with ostectomy. Ann Chir Plast Esthet 66(4):329–337. https://doi.org/10.1016/j.anplas.2020.08.004
Saban Y, Daniel RK, Polselli R, Trapasso M, Palhazi P (2018) Dorsal preservation: the push down technique reassessed. Aesthet Surg J 38(2):117–131. https://doi.org/10.1093/asj/sjx180
Ishida LC, Ishida J, Ishida LH, Tartare A, Fernandes RK, Gemperli R (2020) Nasal hump treatment with cartilaginous push-down and preservation of the bony cap. Aesthet Surg J 40(11):1168–1178. https://doi.org/10.1093/asj/sjaa061
Öztürk G (2021) Combination of crossbar and let-down techniques for dorsal hump and septal correction in rhinoplasty. Ann Plast Surg 86(5):501–507. https://doi.org/10.1097/sap.0000000000002818
D’Ascanio L, Ori M, Finocchi V, Vione N, Capalbo M, Ricci G (2021) Endoscopic “Quick” septoplasty in preservation rhinoplasty. Ann Plast Surg 86(2):137–141. https://doi.org/10.1097/sap.0000000000002461
Öztürk G (2020) New approaches for the let-down technique. Aesthet Plast Surg 44(5):1725–1736. https://doi.org/10.1007/s00266-020-01801-3
Öztürk G (2020) Push-down technique without osteotomy: a new approach. Aesthet Plast Surg 44(3):891–901. https://doi.org/10.1007/s00266-020-01660-y
Patel PN, Abdelwahab M, Most SP (2021) Dorsal preservation rhinoplasty: method and outcomes of the modified subdorsal strip method. Facial Plast Surg Clin North Am 29(1):29–37. https://doi.org/10.1016/j.fsc.2020.08.004
Goksel A, Saban Y (2019) Open piezo preservation rhinoplasty: a case report of the new rhinoplasty approach. Facial Plast Surg 35(1):113–118. https://doi.org/10.1055/s-0039-1678578
Kosins AM, Daniel RK (2020) Decision making in preservation rhinoplasty: a 100 case series with one-year follow-Up. Aesthet Surg J 40(1):34–48. https://doi.org/10.1093/asj/sjz107
Kosins AM (2021) Expanding indications for dorsal preservation rhinoplasty with cartilage conversion techniques. Aesthet Surg J 41(2):174–184. https://doi.org/10.1093/asj/sjaa071
Taglialatela Scafati S, Regalado-Briz A (2021) Piezo-assisted dorsal preservation in rhinoplasty: when and why. Aesthet Plast Surg. https://doi.org/10.1007/s00266-021-02261-z
Saban Y, de Salvador S (2021) Guidelines for dorsum preservation in primary rhinoplasty. Facial Plast Surg 37(1):53–64. https://doi.org/10.1055/s-0041-1723827
Stergiou G, Tremp M, Finocchi V, Saban Y (2020) Functional and radiological assessment after preservation rhinoplasty–a clinical study. In Vivo 34(5):2659–2665. https://doi.org/10.21873/invivo.12085
Finocchi V, Vellone V, Ramieri V, de Angelis F, Marianetti TM (2021) Pisa tower concept: a new paradigm in crooked nose treatment. Plast Reconstr Surg 148(1):66–70. https://doi.org/10.1097/prs.0000000000008064
Keyhan SO, Fallahi HR, Adham G, Cheshmi B (2020) Concomitant dorsal preservation rhinoplasty and orthognathic surgery: a technical note. J Oral Maxillofac Surg 78(9):1630.e1-1630.e10. https://doi.org/10.1016/j.joms.2020.04.015
Ishida J, Ishida LC, Ishida LH, Vieira JC, Ferreira MC (1999) Treatment of the nasal hump with preservation of the cartilaginous framework. Plast Reconstr Surg 103(6):1729–1733
Tuncel U, Kurt A, Saban Y (2022) Dorsal preservation surgery: a novel modification for dorsal shaping and hump reduction. Aesthet Surg J 42(11):1252–1261. https://doi.org/10.1093/asj/sjac069
Patel PN, Abdelwahab M, Most SP (2020) A review and modification of dorsal preservation rhinoplasty techniques. Facial Plast Surg Aesthet Med 22(2):71–79. https://doi.org/10.1089/fpsam.2020.0017
Guyuron B (2020) Discussion: spare roof technique: a new technique for hump removal-the step-by-step guide. Plast Reconstr Surg 145(2):407–408. https://doi.org/10.1097/prs.0000000000006514
Guyuron B, Behmand RA (2003) Nasal tip sutures part II: the interplays. Plast Reconstr Surg 112(4):1130–1145. https://doi.org/10.1097/01.Prs.0000076505.83375.74
Funding
The authors have no funding to disclose.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical Approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Human and Animal Rights
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed Consent
For this type of study, informed consent is not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Guyuron, B., Wells, M.W., Chang, I.A. et al. Common Dorsal Flaws Following Preservation Rhinoplasty: A Systemic Analysis. Aesth Plast Surg 47, 1494–1498 (2023). https://doi.org/10.1007/s00266-023-03437-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-023-03437-5