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Common Dorsal Flaws Following Preservation Rhinoplasty: A Systemic Analysis

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  • Rhinoplasty
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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.

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Authors and Affiliations

  1. School of Medicine, Case Western Reserve University, Cleveland, OH, USA

    Bahman Guyuron, Michael W. Wells & Irene A. Chang

  2. Zeeba Clinic, 29017 Cedar Road, Lyndhurst, OH, 44124, USA

    Bahman Guyuron

  3. Division of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA

    Anthony Deleonibus

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  1. Bahman Guyuron
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  2. Michael W. Wells
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Correspondence to Bahman Guyuron.

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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

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