Guidelines for Dorsum Preservation in Primary Rhinoplasty

Area of Science:

• Plastic Surgery
• Otolaryngology
• Facial Plastic Surgery

Background:

• Growing interest in preservation rhinoplasty (PR) necessitates clear guidelines.
• Decision-making in PR can be complex due to a high volume of scientific articles.
• A focus on benefit-risk ratio and revision rates is crucial for establishing best practices.

Purpose of the Study:

• To analyze revision rates in primary rhinoplasty based on nasal anatomy and surgical techniques.
• To develop evidence-based guidelines for preservation rhinoplasty (PR).
• To correlate nasal profile lines, dorsum preservation (DP) techniques, and septoplasty outcomes with revision rates.

Main Methods:

• Analysis of 352 consecutive primary rhinoplasties from 2016-2019 with 1-year follow-up.
• Classification of nasal profile lines and dorsum preservation (DP) techniques (full DP, DP + resurfacing, bony cartilaginous disarticulation).
• Evaluation of revision rates in subgroups, considering the impact of septoplasties and Cottle's variations.

Main Results:

• Overall revision rate was 9.94% (35 revisions).
• Revision rates varied significantly by nasal type and technique: e.g., tension noses with full DP had 18.18% revisions vs. bony cap resurfacing with 3.13%.
• Associated septoplasty increased the revision rate by 2.50%.

Conclusions:

• Guidelines for primary rhinoplasty based on benefit-risk ratio and revision data are proposed.
• Recommended techniques include full DP for straight noses, DP + resurfacing for tension noses, cartilage-only DP for kyphotic noses, and traditional rhinoplasty for difficult noses.
• Septum stability and associated septoplasty significantly influence outcomes and revision rates.