Preservation rhinoplasty versus conventional structural reduction: a systematic review of aesthetic, functional, and...

Dorsal preservation rhinoplasty aims to maintain the native dorsal roof while achieving aesthetic and functional goals comparable to structural dorsal hump reduction. This systematic review evaluates comparative outcomes, patient-reported measures, and complication patterns across techniques.

A systematic search of PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL was performed from inception to November 1, 2025. Eligible studies included randomized trials, comparative cohorts, and case series with ≥ 10 patients and ≥ 6 months of follow-up. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2 and ROBINS-I. Outcomes included validated PROs, objective airway metrics, aesthetic assessments, and complications.

From 487 records identified, 20 studies met inclusion criteria. Across randomized and nonrandomized comparative studies, dorsal preservation demonstrated aesthetic and functional results equivalent to structural dorsal hump reduction at 6-12 months. Patient-reported improvement (ROE, NOSE, SCHNOS) was consistently favorable in both groups. The only comparative objective airway study showed no significant differences in cross-sectional area or nasal volume. Complication and revision rates were low overall, with pooled recurrence and revision typically between 2-4%.

Current evidence indicates that dorsal preservation rhinoplasty provides outcomes comparable to structural reduction in appropriately selected patients. Standardized reporting and more objective physiologic evaluations are needed.