Avoiding Aesthetic Drawbacks and Stigmata in Dorsal Line Preservation Rhinoplasty

Abstract

For over a century, discussion on the management of nasal dorsum has been a struggle between the techniques of resection and preservation. This is because, each technique has its advantages and disadvantages, with the Joseph technique dominating over the past 30 years despite its surgical stigmas. The dorsum preservation techniques offers a good option for the treatment of nasal hump but like resective techniques it has its drawbacks. This may be the reason why preservation techniques withered but are now making a resurgence. The aim of this article is to describe how to avoid the aesthetic drawbacks of this technique depending on the selected approach.

State of the Evidence for Preservation Rhinoplasty: A Systematic Review

“…The most benefit was seen after dorsal preservation in straight noses with traditional rhinoplasty being suggested in difficult cases or in patients with thick skin across multiple references. 15,20,48 Although there has been an increase in the number of references including PROMs following dorsal preservation techniques since 2019, many of these studies provide low levels of evidence. We identified only four studies that directly compare dorsal preservation techniques to conventional hump resection.…”

Cable and Mirror Sutures and the Nasal Septum Sublaminar Dissection

“…Nevertheless, in two cases, we could observe a deflection of the cartilaginous platform of the nasal dorsum caudal to the NS split (a depression at the cartilage). 13 This was caused by an excessive rotation of the cartilaginous septal flap and an exaggerated force applied to the oblique sutures, and happened in the first cases we performed when there was still no certainty of the force needed to stabilize the structure in the ideal position. This demonstrates the strength and the ability of the sutures to effectively pull the cartilaginous rhinion area down.…”

Modified Dorsal Split Preservation Hybrid Rhinoplasty for Cartilaginous Pushdown and Full Letdown Applications: A PROM-Based Review of 100 Consecutive Cases

“…One of the main advantages of the dorsal split technique is the possibility of fine-tuning the middle vault by trimming the excess of ULCs as needed, and possibly adding symmetric or asymmetric spreader grafts. Excess convexity of the ULCs with middle vault widening after pushdown-letdown is indeed a recognized issue 27 . However, here, no excess convexity of the ULCs will remain after direct trimming and no LKA release maneuver will be needed, thus preventing any potential destabilization.…”

“…Excess convexity of the ULCs with middle vault widening after pushdown-letdown is indeed a recognized issue. 27 However, here, no excess convexity of the ULCs will remain after direct trimming and no LKA release maneuver will be needed, thus preventing any potential destabilization. • Care in leaving a solid septal L-strut.…”