Preservation Rhinoplasty in Contemporary Practice: Integrating Structural and Tissue-Sparing Techniques Along a...

Preservation rhinoplasty (PR) has emerged as a modern alternative to traditional structural techniques, offering a philosophy that emphasizes the conservation of native anatomical structures to achieve functional and aesthetic goals. While historically perceived as dichotomous to structural rhinoplasty, PR is increasingly understood as part of a continuum-where hybridization allows for individualized, anatomy-guided surgical planning.

This comprehensive review outlines the evolution, philosophical foundations, anatomical principles, and surgical techniques of PR, with a focus on dorsal preservation strategies. Specific attention is given to surface versus impaction techniques, septal management, tip plasty, and alar preservation. Additionally, the integration of powered instrumentation, preoperative imaging, and surgical approach selection are discussed, along with considerations for patient selection, outcomes, and complication profiles.

Current literature supports PR as a safe and effective technique with favorable aesthetic and functional outcomes, particularly when applied to appropriately selected patients. Comparative studies show that PR achieves equivalent-if not superior-results to traditional methods in certain populations, with high patient satisfaction and low revision rates. However, limitations remain, including technique-specific complications such as dorsal hump recurrence and internal nasal valve narrowing.

PR represents a valuable addition to the rhinoplasty armamentarium. Rather than replacing structural approaches, it offers a complementary set of techniques that can be selectively employed based on patient anatomy and goals. Surgeons should be encouraged to incorporate preservation principles through a gradual skill-building approach, expanding their skillset and ultimately fostering a more personalized and functionally stable rhinoplasty practice.