The Ballerina Maneuver: A Lateral Keystone Release Technique in Preservation Rhinoplasty

Preservation rhinoplasty (PR) aims to maintain the natural dorsal aesthetic lines while reducing dorsal height and achieving a harmonious dorsal contour. Creating a refined dorsal concavity may be challenging, particularly in patients with low-to-moderate humps who desire a more elegant dorsal profile while preserving the structural integrity of the native dorsum. The Ballerina maneuver was developed as an adjunctive technique designed to enhance dorsal concavity.

The aim of this study was to describe the Ballerina maneuver and illustrate its role in refining dorsal contour in PR. We hypothesized that this maneuver would allow controlled enhancement of dorsal concavity while maintaining dorsal stability and supporting harmonious dorsal aesthetics.

Technical description of a surgical maneuver.

The Ballerina maneuver was performed as an adjunctive step during PR in selected patients seeking a more concave dorsal profile. The technique focused on controlled modification of the middle vault structures while preserving the continuity of the native dorsum. The surgical concept, technical steps, and key considerations were described to facilitate safe and reproducible application. Representative clinical cases were presented to illustrate the surgical application of the maneuver and its role in dorsal contour refinement.

In the representative cases, the maneuver facilitated controlled caudal repositioning of the osseocartilaginous vault and contributed to a smoother, more concave dorsal contour while preserving the continuity of the native dorsum.

The Ballerina maneuver represents a reproducible adjunctive technique for refining dorsal contour in PR. By enabling controlled enhancement of dorsal concavity while maintaining the integrity of the native dorsal framework, the maneuver supports the core principles of structural preservation and may expand the surgical armamentarium for achieving natural dorsal contour refinement.