Dorsal preservation rhinoplasty (PR-D) attempts to preserve as much of the native nasal anatomy as possible when performing a hump reduction, but clinical outcomes are unclear.
Objective:
In patients undergoing PR-D rhinoplasty, this article investigates the rates of complications and revisions.
Methods:
This meta-analysis was prospectively registered on the PROSPERO database. The Pubmed, Embase, and Scopus databases were searched. Pooled incidence was calculated in a meta-analysis within a random-effects model.
Results:
Twenty-two studies representing a cohort of 5660 patients were included in this study. Postoperative hump recurrence rates (4.18%, 95% confidence interval [CI]: 2.41–6.40%), rates of revision rhinoplasty (3.48%, 95% CI: 1.77–5.74%), rates of postoperative nasal deviation (1.13%, 95% CI 0.37–2.28%), and rates of infection (1.89%, 95% CI: 0.35–4.62%) were all found to be low.
Conclusion:
PR-D has low rates of revision surgery, residual or recurrent hump, postoperative nasal deviation, and postoperative infection.
Get full access to this article
View all access options for this article.
References
1.
DanielRK.The Preservation Rhinoplasty: A New Rhinoplasty Revolution. USA: Oxford University Press;. 2018.
2.
GoodaleJL.A new method for the operative correction of exaggerated Roman nose. Boston Med Surg J. 1899; 140(5):112.
3.
LothropOA.An operation for correcting the aquiline nasal deformity; the use of a new instrument; report of a case. Boston Med Surg J. 1914; 170(22):835–837.
4.
CottleMH.Nasal roof repair and hump removal. AMA Arch Otolaryngol. 1954; 60(4):408–414.
5.
JosephJ.Rhinoplasty and Facial Plastic Surgery: With a Supplement on Mammaplasty and Other Operations in the Field of Plastic Surgery of the Body: An Atlas and Textbook. Phoenix, Arizona: Norman Publishing; 1987.
6.
DanielRK, KosinsAM. Current Trends in Preservation Rhinoplasty. USA: Oxford University Press; 2020:ojaa003.
7.
SabanY, DanielRK, PolselliR, TrapassoM, PalhaziP. Dorsal preservation: the push down technique reassessed. Aesthetic Surg J. 2018; 38(2):117–131.
8.
FerreiraMG, MonteiroD, ReisC, e SousaCA. Spare roof technique: a middle third new technique. Fac Plast Surg. 2016; 32(01):111–116.
9.
FerreiraMG, SantosM, e CarmoDO, et al.Spare roof technique versus component dorsal hump reduction: a randomized prospective study in 250 primary rhinoplasties, aesthetic and functional outcomes. Aesthetic Surg J. 2021; 41(3):288–300.
10.
AbdelwahabMA, NevesCA, PatelPN, MostSP. Impact of dorsal preservation rhinoplasty versus dorsal hump resection on the internal nasal valve: a quantitative radiological study. Aesthetic Plast Surg. 2020; 44(3):879–887.
11.
PatelPN, AbdelwahabM, MostSP. Dorsal preservation rhinoplasty: method and outcomes of the modified subdorsal strip method. Fac Plast Surg Clin N Am. 2021; 29(1):29–37.
12.
SadriA, EastC, BadiaL, SabanY. Dorsal preservation rhinoplasty: core beam computed tomography analysis of the nasal vault, septum, and skull base—its role in surgical planning. Fac Plast Surg. 2020; 36(03):329–334.
13.
SabanY, de SalvadorS. Guidelines for dorsum preservation in primary rhinoplasty. Fac Plast Surg. 2021; 37(01):053–064.
14.
TuncelU, AydogduIO, KurtA. Reducing dorsal hump recurrence following push down-let down rhinoplasty. Aesthetic Surg J. 2021; 41(4):428–437.
15.
MoherD, LiberatiA, TetzlaffJ, AltmanDG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009; 151(4):264–269.
ÖztürkG.Combination of the push-down and let-down techniques: mix-down approaches. Aesthetic Plast Surg. 2021; 45(3):1140–1149.
19.
ÖztürkG.Prevention of nasal deviation related to preservation rhinoplasty in non-deviated noses using suturing approaches. Aesthetic Plast Surg. 2021; 45(4):1693–1702.
20.
IshidaJ, IshidaLC, IshidaLH, VieiraJ, FerreiraMC. Treatment of the nasal hump with preservation of the cartilaginous framework. Plast Reconstr Surg. 1999; 103(6):1729–1733; discussion 1734.
21.
BoulangerN, BaumannC, BeurtonR, et al.Septorhinoplasty by disarticulation: early assessment of a new technique for morphological correction of crooked noses. Rhinology. 2013; 51(1):77–87.
22.
CabbarzadeC.A new algorithm for hump reduction according to dynamics of dorsal preservation. Aesthetic Surg J. 2019; 39(12):NP547–NP549.
23.
DewesW, ZappeliniCE, FerrazMB, NevesJC. Conservative surgery of the nasal dorsum: septal pyramidal adjustment and repositioning. Fac Plast Surg. 2021; 37(01):022–028.
24.
FinocchiV, VelloneV, GiorgioMR, DanielRK. A 3-level impaction technique for dorsal reshaping and reduction without dorsal soft tissue envelope dissection. Aesthetic Surg J. 2021 [Online ahead of print], DOI: 10.1093/asj/sjab261.
25.
FinocchiV, VelloneV, RamieriV, de AngelisF, MarianettiTM. Pisa tower concept: a new paradigm in crooked nose treatment. Plast Reconstr Surg. 2021; 148(1):66–70.
26.
KeyhanSO, FallahiHR, AdhamG, CheshmiB. Concomitant dorsal preservation rhinoplasty and orthognathic surgery: a technical note. J Oral Maxillofac Surg. 2020; 78(9):1630.e1–1630.e10.
27.
KosinsAM, DanielRK. Decision making in preservation rhinoplasty: a 100 case series with one-year follow-up. Aesthetic Surg J. 2020; 40(1):34–48.
28.
KosinsAM.Expanding indications for dorsal preservation rhinoplasty with cartilage conversion techniques. Aesthetic Surg J. 2021; 41(2):174–184.
29.
ÖztürkG.Semi–let-down and semi–push-down preservation techniques: maintaining the Intactness of the Distal Region. Aesthetic Surg J. 2021; 41(6):NP267–NP280.
30.
SantosM, Rego ÂR, CoutinhoM, SousaCAe, FerreiraMG. Spare roof technique in reduction rhinoplasty: prospective study of the first one hundred patients. Laryngoscope. 2019; 129(12):2702–2706.
31.
StergiouG, FortunyCG, SchweiglerA, FinocchiV, SabanY, TrempM. A multivariate analysis after preservation rhinoplasty (PR)–a prospective study: preservation rhinoplasty and outcome. J Plast Reconstr Aesthetic Surg. 2021, DOI: 10.1016/j.bjps.2021.05.073.
32.
IshidaLC, IshidaJ, IshidaLH, TartareA, FernandesRK, GemperliR. Nasal hump treatment with cartilaginous push-down and preservation of the bony cap. Aesthetic Surg J. 2020; 40(11):1168–1178.
33.
TuncelU, AydogduO. The probable reasons for dorsal hump problems following let-down/push-down rhinoplasty and solution proposals. Plast Reconstr Surg. 2019; 144(3):378e–385e.
34.
ScafatiST, Regalado-BrizA. Piezo-assisted dorsal preservation in rhinoplasty: when and why. Aesthetic Plast Surg. 2021 [Online ahead of print], DOI: 10.1007/s00266-021-02261-z.
35.
TaşS.Dorsal roof technique for dorsum preservation in rhinoplasty. Aesthetic Surg J. 2020; 40(3):263–275.
36.
Gonçalves FerreiraM, ToriumiDM. A practical classification system for dorsal preservation rhinoplasty techniques. Fac Plast Surg Aesthetic Med. 2021; 23(3):153–155.
Sharif-AskaryB, CarlsonAR, Van NoordMG, MarcusJR. Incidence of postoperative adverse events after rhinoplasty: a systematic review. Plast Reconstr Surg. 2020; 145(3):669–684.
43.
MoubayedSP, IoannidisJP, SaltychevM, MostSP. The 10-item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) for functional and cosmetic rhinoplasty. JAMA Fac Plast Surg. 2018; 20(1):37–42.
44.
PageMJ, McKenzieJE, BossuytPM, et al.The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
