Preservation Push-Up Rhinoplasty with a Dorsal Preservation Graft: A Paradigm Shift in Aesthetic Augmentation...

Dorsal augmentation remains a cornerstone in aesthetic rhinoplasty, particularly among patients with flat or low nasal dorsum, short nose deformity, and wide dorsal bases, features commonly observed in ethnic populations such as those from Northeast India. Traditional onlay grafting techniques, including solid cartilage grafts and diced cartilage fascia (DCF), though widely used, are limited by issues such as postoperative warping, graft visibility, displacement, and prolonged healing periods requiring high patient compliance. While these techniques focus on augmentation, they often disrupt the native dorsal framework, compromising long-term stability and anatomical harmony. This paper introduces a novel graft design, the dorsal preservation graft (DPG), along with its indications and a refined surgical approach aimed at overcoming these limitations. The DPG is strategically positioned beneath the native dorsal framework using a high septal cut, allowing for controlled and stable augmentation while maintaining the integrity of the original nasal architecture. A stable support system is provided beneath the graft, along with secure, multi-point fixation that ensures proper stabilization. This foundational stability is the principle behind the long-term structural and aesthetic success of the technique. This technique enables targeted dorsal and radix elevation, preserves dorsal aesthetic lines, and allows correction of associated deformities like short nose and dorsal widening. By combining structural support with preservation principles, the DPG approach offers a reliable, customizable, and anatomically respectful alternative to traditional dorsal grafting.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.springer.com/00266 .