Clarification and Classification of Dorsal Preservation Rhinoplasty: Lessons from a Continuous 1,191-Case Experience

Dorsal preservation rhinoplasty (DPR) has attracted significant attention in recent years. However, the rapid dissemination of diverse techniques and terminology has generated confusion regarding definition, indications, methodology, and outcomes. A unified conceptual framework remains lacking.

We retrospectively reviewed 1,191 consecutive primary rhinoplasties performed by a single senior surgeon between 2010 and 2024. Three chronological series were analyzed. Series 1 (2010-2014; n = 320) introduced push-down and let-down osteotomies in selected cases. Series 2 (2015-2019; n = 352) expanded indications to more complex morphologies, exposing limitations. Series 3 (2020-2024; n = 519) applied a unified framework developed from the previous series. Revision rates and clinical lessons were compared.

Series 1 reported 11 revisions (3.4%), confirming feasibility in favorable cases. Series 2 recorded 35 revisions (9.9%) during the uncontrolled expansion of indications. Series 3 demonstrated 17 revisions (3.3%) after refinement of patient selection and operative decision-making informed by earlier experience, with revision rates differing significantly across the three series (χ²(2) = 21.61, p < 0.001). The third series validated that systematic application of a dorsal preservation framework produced reliable outcomes, minimized revisions, and helped formulate a pyramidal classification with named septoplasty modulators.

The evolution of DP rhinoplasty follows a U-shaped learning curve, characterized by initial proof-of-concept, uncontrolled expansion, and subsequent consolidation through classification. Integration of the pyramidal framework with W-point septoplasty clarifies terminology, standardizes methodology, and establishes DP rhinoplasty as a reproducible and mature approach in contemporary practice.