Commentary on: A 3-Level Impaction Technique for Dorsal Reshaping and Reduction Without Dorsal Soft Tissue Envelope Dissection.

Abstract

Preservation rhinoplasty: the revolution continues. The technique described by the authors in “A 3-Level Impaction Technique for Dorsal Reshaping and Reduction Without Dorsal Soft Tissue Envelope Dissection” furthers the ongoing revolution in rhinoplasty surgery and provides additional insights.1 As surgeons continue to apply the concepts of preservation rhinoplasty, and specifically dorsal preservation, an algorithm is presented in this paper that illustrates this paradigm shift for treating the dorsum without osseocartilaginous resection. For decades the focus of the rhinoplasty surgeon has been on increasing the predictability and stability of reductive techniques via grafting to improve long-term functional and aesthetic outcomes. These structural techniques have allowed surgeons to maintain better control of the operation in the short and medium term. However, long-term results remain a challenge, particularly at the keystone and middle vault; surgeons often watch their beautiful operation partially deteriorate over time secondary to shrink-wrap forces, structural deterioration, graft resorption,...