Preservation Rhinoplasty in the Saddle Nose: The Reverse Spare Roof Technique

Saddle nose deformity (SND) is a pathological entity resulting from loss of dorsal height caused by a substantial decrease in the cartilaginous vault or bony vault, and it can occur after a variety of nasal pathological conditions.¹ Most saddle nose deformities are secondary to surgery or trauma, but congenital causes do exist.¹ Repair of saddle nose, therefore, represents one of the most challenging problems in nasal surgery, requiring long-term structural support while avoiding sacrifice of aesthetics.² To achieve the desired results, various materials have been employed for nasal contour restoration. The most used grafts are autologous cartilages. Septal cartilage is ideal for reconstruction but often insufficient except in mild cases. Thus, conchal and costal cartilage grafts are the most used in moderate and severe nasal saddling. Augmentation rhinoplasty (AR) is a common procedure in Negroid and Asian patients due to their constitutional lack of dorsal projection. The purpose of this article is to introduce the reverse spare roof technique (rSRT) and its usefulness to correct SND and in AR. To the best of the author's knowledge, this is the first technique that applies the actual principles of preservation rhinoplasty in the correction of the SND and AR.