Preservation Rhinoplasty (Let-Down Technique) for Endonasal Dorsal Reduction

Preservation rhinoplasty has been a trending topic in the rhinoplasty literature. There is no single technique that can correct all structures; therefore, patient analysis is paramount. This article focuses on the anatomy of the keystone area and the dynamics of the dorsum explained through the biotensegrity concept. Differences between push-down and let-down techniques are addressed from a nasal valve physiology point of view. The let-down technique maintains the tensegrity of the nasal pyramid. Preservation should be preferred, in most cases, over resection, as well as reposition over manipulation.