“…Common to all of those, whether founded on surface or foundation techniques 7 and applying, symmetrically or not, a pushdown or letdown mobilization of the nasal pyramid on circumferential impaction osteotomies, is the key concept of preserving the whole nasal dorsum intact. A notable exception was that of a pushdown limited to the cartilaginous dorsum or extended to the bony cap,combined with conventional osteotomies of the bony vault, as described by Ishida and Ferreira [8][9][10][11] .Though PR was described under a closed approach it was also performed open by many, with the benefit of full visualization, precise piezo osteotomies and piezo or burr osteoplasty 12,13 together withthe advantage of possibly combining with a structural approach to the tip 3,4,14 . This contemporary concept essentially constitutes a "hybrid" preservation-structural approach 14,15 .…”