Shaping the Future of Nasal Surgery: A Systematic Review of Preservation Rhinoplasty

Preservation rhinoplasty has transformed nasal surgery by prioritizing structural conservation while achieving aesthetic refinement and functional optimization. Unlike traditional rhinoplasty, which relies on extensive resection and reconstruction, preservation techniques aim to maintain key anatomical components, reducing complications and improving long-term stability. Recent advancements, including open dorsal preservation approaches and hybrid rhinoplasty techniques (bridging preservation and structural concepts), have expanded its indications, making it applicable to a broader range of nasal deformities and functional impairments. However, the efficacy, limitations, and functional outcomes of these techniques remain to be synthesized.

A systematic review was conducted following PRISMA 2020 guidelines, searching PubMed/MEDLINE, EMBASE, and Web of Science databases up to March 1^st, 2025. Studies evaluating surgical techniques, functional and aesthetic outcomes, complications, and patient satisfaction in preservation rhinoplasty were included. Given the heterogeneity of study designs and outcome measures, a narrative synthesis was performed.

Thirteen studies comprising 855 patients were included, with publication years ranging from 2020 to 2024 and a mean Newcastle-Ottawa Scale score of 5.8 (SD 0.4), indicating moderate methodological quality. Dorsal preservation techniques-including push-down, let-down, and subdorsal strip methods-consistently yielded favorable results. Patient satisfaction was high, with Rhinoplasty Outcome Evaluation (ROE) scores exceeding 85 in up to 90.3% of patients. Functional improvement was reported across techniques, with increased nasal patency scores and reduced Nasal Obstruction Symptom Evaluation (NOSE) scores. Hybrid approaches such as mix-down and Low Strip Unifying Hybrid Rhinoseptoplasty (LUHRS) were especially beneficial in complex nasal anatomies, with RHINO scores rising from 37.6 to 88.2. Reported revision rates across all approaches ranged from 0 to 7.9%, typically addressing minor contour irregularities without major complications.

Preservation rhinoplasty has emerged as a potentially promising alternative to traditional structural techniques and may offer favorable dorsal contour preservation, low reported complication rates, and high levels of patient satisfaction in selected patients. Careful patient selection appears to remain essential, with ideal candidates often presenting with straight nasal profiles, minimal dorsal deviation, and relatively intact nasal anatomy. While early outcomes are encouraging, the predominance of observational data, limited use of standardized objective functional assessments, and relatively short follow-up periods restrict definitive conclusions regarding long-term durability and comparative effectiveness. Future research should aim to further refine patient selection criteria, clarify the role of hybrid techniques in more complex cases, and explore the integration of technologies such as 3D imaging and artificial intelligence to potentially enhance surgical planning and outcome assessment in modern nasal surgery.

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