Dorsal Hump Research Articles

Bony Dorsal Preservation.

Rhinoplasty is undergoing a transformation with the re-emergence of Dorsal Preservation Rhinoplasty (DPR) techniques. This article introduces a novel addition to the DPR repertoire, "Bony Dorsal Preservation" (BDP), which has particular application for the correction of crooked noses. In this comprehensive overview, we summarize current DPR concepts and techniques, the intricate considerations that go into the dorsal osseocartilaginous vault and septal management, and how these are modified to treat the crooked nose. However, current DPR techniques, particularly the Low Septal Strip (LSS), have drawbacks, and the desire to address such issues led to the development of BDP. BDP is ideal for cases where there is no septal base pathology. It maintains the core principle of DPR by lowering dorsal humps without creating open roof deformities. Its unique feature lies in the temporary separation of the upper lateral cartilages from the septum while leaving the septal base attachment intact, thus allowing the entire osseocartilaginous vault to be adjusted independently before reconnecting the preserved upper lateral cartilages. This technique offers direct visualization during septal excision and fixation and enables cartilaginous vault movement without sacrificing stability. Compared to LSS, there is more septal cartilage available for harvesting, the risks of a single point of septal fixation are eliminated, and there is the potential to transition to component reduction techniques if needed. With shared indications and contraindications with other DPR methods, BDP emerges as a valuable addition to the evolving field of rhinoplasty, particularly in addressing the challenges of the crooked nose.

Types of nasal deformities in individuals seeking rhinoplasty at governmental hospital in Saudi Arabia.

This study explores the profound impact of nasal structure on individuals' self-image and emotional well-being, emphasizing the increasing popularity of rhinoplasty in Saudi Arabia, influenced by societal beauty standards portrayed on social media. The investigation aims to unravel the complex interplay between demographic factors, such as gender and age distribution, and prevalent nasal deformities in a cohort of 293 participants. This retrospective study at the University of Hail and King Khalid Hospital, Saudi Arabia, investigated nasal deformities in 293 participants aged 15-54. Ethical approval was obtained, and data, including bio-demographics and nasal deformities, were retrospectively reviewed. Statistical analyses, utilizing chi-square and Fisher exact tests, assessed associations, enhancing internal validity. The study targeted a diverse population, emphasizing ethical guidelines and systematic sampling. Our study of 293 participants revealed a prevalence of common nasal deformities. Dorsal hump deformity (59.0%) was the most prevalent, followed by external nasal deviation (54.6%). Significant gender differences were observed, with males more prone to external nasal deviation (65.6%), while decreased nasal tip rotation was more common in females (40.6%). Variations in nasal tip shape were statistically significant, with broad nasal tip shape more prevalent in females (35.2%). In conclusion, our study highlights the prevalence of common nasal deformities, emphasizing significant gender variations. These findings contribute to a deeper understanding of nasal anatomy, essential for informed decision-making in rhinoplasty.

Narrowing the Nasal Roof with Paramedial Osteotomy in Preservation Rhinoplasty.

Rhinoplasty is frequently performed in aesthetic and plastic surgery, with hump deformity being common in Western populations. Osteotomies play a crucial role in managing this, especially for dorsal hump reduction in closed rhinoplasty. Despite advancements, treatments for simultaneous nasal hump deformity and wide nasal roof are inadequate in preservation rhinoplasty. This study introduces a technique merging push-down and let-down methods with paramedial osteotomy for these cases. A retrospective review was conducted on patients undergoing push-down or let-down rhinoplasty, identifying 68 individuals (51 females and 17 males) with both nasal hump deformity and wide nasal roof. They were evaluated using the Rhinoplasty Outcome Evaluation questionnaire before surgery and 1-year post-operation. Follow-up ranged from 12 to 24months, with significant improvement in patient satisfaction. The median Rhinoplasty Outcome Evaluation score rose from 48.5 pre-surgery to 91.5 post-surgery (p < 0.001), indicating remarkable patient satisfaction in 97.3% of cases. This research is to demonstrate narrowing the nasal roof in patients who had nasal hump deformity and wide nasal roof with a combination of dorsal preservation techniques and osteotomy. Surgeons experienced in push-down or let-down techniques can apply this combination technique to obtain better aesthetic outcomes in patients with a wide nasal roof. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Feasibility of Dorsal Preservation Rhinoplasty for Hump Nose Reduction in Asian Population.

Background: Dorsal preservation rhinoplasty (DPR) has shown promise in Western populations for nasal hump reduction, but its feasibility and long-term outcomes in Asian individuals remain unexplored. Objective: To measure the feasibility, as well as the functional and aesthetic outcomes, of DPR in Asian hump noses and to determine its effectiveness in adaptation to the unique characteristics of the Asian demographic. Methods: A retrospective review analyzed patients who underwent primary DPR between April 2019 and November 2022 with a follow-up period of over 12 months. The study included patients whose photographs met the criteria. Surgical techniques, aesthetic measurements using anthropometric factors, and subjective outcomes were evaluated. Results: Of the 17 patients (11/17, 64.7% female), the mean age was 22.53 years (standard deviation [SD] 5.22 years). The median follow-up period was 36.90 months (range 13-61 months). Measurements from pre- and postoperative photographs showed a significant reduction in both nasofacial angle (7.76°, SD 4.30°) and rhinion angle (0.85°, SD 0.69°) (p < 0.0001). Patient-reported outcome scores with the Nasal Obstruction Symptom Evaluation scale decreased from 61.00 (SD 26.96) to 15.50 (SD 11.65), and Standardized Cosmesis and Health Nasal Outcomes Survey scores postoperatively were 10.90 (SD 7.71) overall, with the functional component at 3.50 (SD 2.64) and the aesthetic component at 7.40 (SD 6.24). No residual hump, recurrence of the hump, or complications were observed. Conclusion: In this study, the use of DPR techniques was effective and may support further development of the inclusion and exclusion criteria for its use in correcting the dorsal hump in Asian patients. Careful patient selection will be imperative to determine the ultimate indications for this technique.

Persistent cosmetic dissatisfaction in rhinoplasty &amp; management of the difficult patient

The rhinoplasty surgeon will undoubtedly encounter a cosmetic patient who is persistently dissatisfied with their results, no matter the objective outcome achieved. This article seeks to describe risk factors for postoperative dissatisfaction and highlight effective management strategies for the “difficult patient.” A literature search was performed using PubMed and Embase databases during September and October of 2023 to identify articles that analyzed factors related to dissatisfaction in rhinoplasty. Forty unique references were identified. The majority of structural aesthetic complaints related to dissatisfaction after rhinoplasty were residual dorsal hump (20%) or persistent tip dissatisfaction (19%-37%). Demographic factors including younger age, male sex, self-referral, history of body dysmorphic disorder or abuse/neglect were risk factors for postoperative dissatisfaction. Ineffective patient-provider communication, litigation due to inadequate informed consent, and surgeon inattentiveness were contributing factors to postoperative dissatisfaction. Revision rhinoplasty rates ranged from 5%-15%, where most patients sought revision surgery due to the development of a new deformity or failure to correct the original deformity, with the greatest complaints at the nasal bridge and nasal tip. Validated patient-reported outcome measures including Rhinoplasty Outcome Evaluation (ROE) and FACE-Q can be effective questionnaires to assess satisfaction. Appropriate patient selection, adequate preoperative counseling and consent, effective communication, and reaching a consensus about surgical goals are all effective strategies in the management of a dissatisfied patient.

Preventing Hump Recurrence in Dorsal Preservation Rhinoplasty: The Five Key Tenets

SUMMARY: Preservation rhinoplasty has re-emerged over the past decade and continues to gain traction in the rhinoplasty community. Dorsal preservation rhinoplasty (DPR), one of the tenets of preservation rhinoplasty, centers on preservation of the native osseocartilaginous joint of the dorsum, with changes instead achieved through modification of the underlying septal cartilage and surrounding bony nasal pyramid. However, one complication unique to DPR is the phenomenon of hump recurrence, where tensile forces or memory lead to a recurrent convexity of the dorsal hump. Hump recurrence is the most common complication after DPR and often requires revisionary surgery. Accordingly, strategies to reduce the incidence of hump recurrence are highly sought after. In this article, we describe the senior author’s main tenets of preventing hump recurrence in DPR, focusing on 1. Appropriate patient selection; 2. Addressing anatomic blocking points; 3. Adding mechanical fixation of the cartilaginous vault with suture techniques depending on the level of septal manipulation; 4. Applying a graduated approach to DPR procedural selection; and 5. Ancillary measures to control the shape of the nasal dorsum. Implementation of each of these five tenets is critical for modern rhinoplasty surgeons to reduce the incidence of hump recurrence in their preservation rhinoplasty practices.

Advancing the Era of Liquid Rhinoplasty: A Methodological Approach to Injection Protocols.

Liquid rhinoplasty, a non-surgical procedure using hyaluronic acid (HA) to reshape and refine the nose, has gained in popularity as an alternative to traditional surgical rhinoplasty although its results are not definitive. However, the lack of standardized injection protocols has raised concerns about treatment consistency and patient safety. In this article, the authors propose a systematic protocol for the most common indications of liquid rhinoplasty. By adopting a standardized methodology, healthcare professionals can enhance patient safety, improve treatment consistency, and optimize patient satisfaction. The protocol includes standardized injection sites categorized as dorsal, paramedian, tip and endonasal injections. Specific injection areas are recommended for different nasal shapes such as droopy noses, dorsal humps, nasal saddle deformity, inverted V deformity, tip shape abnormalities, twisted noses, revision cases with dorsal irregularities, and internal nasal valve dysfunction. While variations in filler dosages may be necessary based on individual patient needs, a conservative approach is recommended to maintain natural-looking results and reduce the risk of complications. The increase in non-surgical techniques for nasal refinement offers patients more options, and systematized injection protocols based on different nasal types provide a structured framework for liquid rhinoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Correcting Different Degrees of Droopy Nose, an Overview of Techniques and Strategies at Tertiary Facial Plastic Center. A Retrospective Analysis.

The variety of noses in the mixed Saudi population keeps rhinoplasty surgeons on their toes. The main treatment goal for drooping nose tips is the first rotation of the nasal tip superiorly. Although droopy nose is a common disease in Saudi Arabia, none of the previous studies recognized the general features of droopy nose. A retrospective analysis of 352 patients with nasal drooping nose from 2016 to 2022. The main outcome measurements were general characteristics of nasal tip ptosis, and the most common surgical techniques used to treat nasal tip ptosis in a tertiary hospital. Analysis of 352 patients with droopy nose showed that 29.0% were between 25 and 29 years old, and 56.3% were female patients. The most common characteristic seen with droopy nasal tip was a significant dorsal hump in 64.8% of patients, followed by amorphous, boxy, and bulbous nasal tip in 33.5%. Significant dorsal hump and bifid tip were more common between 18 and 24. Meanwhile, amorphous, boxy, and bulbous nasal tip were more common in female individuals. The surgical techniques mostly addressed the underlying cause, which was tip grafting (83.0%), lateral osteotomy (77.3%), hump removal (66.5%), lateral crura method (61.9%), and septal extension graft (40.9%). The research concluded that the surgeon should be familiar with the patient's underlying cause of nasal tip ptosis and use surgical techniques accordingly. To get a pleased long-term outcome, it is often essential to repair the inferiorly rotated tip using more than one surgical approach.

Dorsal preservation rhinoplasty versus dorsal hump reduction: a randomized prospective study, functional and aesthetic outcomes.

To compare the functional and esthetic outcomes of dorsal preservation rhinoplasty (DPR) and conventional dorsal hump reduction (DHR) in primary rhinoplasty using patient-reported outcome measures (PROMs) and cone beam computed tomography (CBCT). In our randomized prospective double-blinded clinical trial, 50 patients had dorsal nasal hump surgery between October 2021 and November 2022 in our tertiary referral center. All surgeries were done by the same surgeon. Patients were randomly assigned to two groups: Group (A): 25 patients had DPR, and group (B): 25 patients underwent DHR. Pre-operative and post-operative evaluations were conducted using standardized cosmesis and health nasal outcomes survey (SCHNOS), surgeons' rhinoplasty evaluation questionnaire (SREQ), and the CBCT. Following an average of 7.22 ± 2.07 months, patients in both groups reported significantly higher levels of satisfaction, as measured by the SCHNOS score (p < 0.001) and the average of three SREQ scores (p < 0.001). These results align with the radiological analysis, which denoted an overall improvement in the average of both sides' internal nasal valve angle and cross-sectional area after surgery with (p = 0.001) and (p = 0.085), respectively, for the DPR group and with (p = 0.281) and (p = 0.014), respectively, for the DHR group. There was no statistically significant difference in outcomes between both groups (p > 0.05). Dorsal preservation is a viable alternative to conventional dorsal hump reduction in primary rhinoplasty. There was no difference in the functional and esthetic outcomes between both techniques, which were verified by radiological investigation.

Comparison of Functional and Cosmetic Outcomes Between Dorsal Preservation and Spreader Flap Rhinoplasty: A Randomized Trial.

Preservation rhinoplasty is a novel and increasingly utilized method in nasal plastic surgery. The study aimed to compare the functional and aesthetic outcomes of dorsal preservation rhinoplasty, a new and interesting method, with conventional hump resection. A total of 84 rhinoplasty applicants were randomly assigned to 2 groups. The first group underwent convention dorsal hump resection with spreader flap midvault reconstruction and the second group underwent dorsal preservation rhinoplasty with the modified subdorsal strip method. Aesthetic and functional outcomes, including residual hump, nasal width, projection, and rotation, were evaluated after 1 year with the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS), visual analog scale (VAS), and image analysis. Eighty-four patients with a mean age of 30.96 ± 6.75 years were recruited, of whom 15 (17.6%) were male. There were no significant differences in confounding variables between the 2 groups. There were no significant differences in residual hump (P = .11), nasal width (P = .37), projection (P = .70), rotation (P = .79), VAS (P = .81), or SCHNOS (P = .90) between the 2 groups. Dorsal preservation rhinoplasty with the modified subdorsal strip method may have comparable aesthetic and functional outcomes to spreader flaps midvault reconstruction.

Rhinoplasty Preferences: Can the Public Detect Prior Surgery on Social Media?

The creation of postoperative rhinoplasty results that appear natural and proportional to the face are crucial for patient satisfaction. The purpose of this study was to assess the public's ability to detect a post-rhinoplasty result and preference of preoperative and postoperative rhinoplasty outcomes. A survey was distributed using the Amazon Mechanical Turk online platform showing nine preoperative and postoperative rhinoplasty patients. Participants rated aesthetic appearance, identified areas of abnormality, and stated whether they believed the patient had undergone prior rhinoplasty. A total of 456 responses were included. On a scale of 1-5 with 5 being the most aesthetically pleasing, the highest rated nose was a postoperative patient without visible deformities (3.95, SD 1.07) followed by the postoperative patient with a resultant bulbous tip (3.48, SD 0.96). The lowest ranking noses were the prior rhinoplasty with resultant saddle nose deformity (3.02, SD 1.19) and the prior rhinoplasty with nasal trapezoid deformity (2.95, SD 1.04). The public was able to correctly determine if patients had prior rhinoplasty surgery only if there were resultant defects. When respondents believed that the patient had undergone prior rhinoplasty, their average rating was lower than those who believed they had not undergone surgery (3.74/5 vs. 4.15/5, p < 0.0001). The belief that someone had previously undergone rhinoplasty led the public to rate the aesthetic appearance of the nose lower. To provide optimal results following rhinoplasty, surgeons may therefore seek to provide a natural, "un-operated" look. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Differences for nasal aesthetic preferences exist and vary based on geographic region The public is unable to discern if a patient previously underwent rhinoplasty if the result does not show a postoperative defect, such as a dorsal hump, over-rotated tip, or mid-vault collapse Oppositely, the public can generally tell if patients have undergone rhinoplasty surgery if a postoperative deformity is present The belief that someone had rhinoplasty surgery negatively impacts the attractiveness ranking of the nose, even without any postoperative defects present.

Use of three-dimensional uCT imaging technique in the description of a new deepsea slipper lobster Bathyarctus andamanicus sp. nov. (Crustacea: Decapoda: Scyllaridae) from Myanmar

A new deepsea slipper lobster Bathyarctus andamanicus sp. nov. was discovered from the Andaman Sea during a recent “Nansen” survey cruise, a collaboration between the FAO and the Myanmar government. The new species closely resembles Bathyarctus formosanus (Chan and Yu, 1992) but with a distinctly higher dorsal hump at the abdominal somite IV and a much larger blue patch on the abdominal tergite I. The status of the new species is supported by molecular genetic data and B. formosanus is also recorded for the first time from the Philippines. Micro-CT scanned method was used to illustrate the characteristics of B. andamanicus sp. nov. and B. formosanus, with the first construction of a cybertype for the infraorder Achelata Scholtz and Richter, 1995.

Pollybeak deformity: how to avoid, how to cure.

We reviewed the Pollybeak deformity from prevention to treatment in all aspects. Research methods included searching online databases such as Google, Google Scholar, PubMed, and Proquest Central at King Saud University. We used terms like "Pollybeak deformity", "rhinoplasty", "etiology", and "treatment" to find related articles. Pollybeak deformity, an undesirable side effect of rhinoplasty, manifests as a dorsal nasal convexity resembling a parrot's beak. A dorsal hump that develops in the supratip region of the nose "pushes" the tip down, leading to under-rotation. Several factors may be at play here. When a surgeon fails to recognize the aberrant tip-supratip relationship that distinguishes this abnormality during the intraoperative evaluation of the nose, the result is a pollybeak. There is also the risk of pollybeak deformity, which the surgeon might be unable to predict. Supratip scar tissue is more common in people with thick skin and soft tissue envelopes. Medical intervention is only effective for soft-tissue pollybeaks when caught early. Injecting corticosteroids into the supratip dead space can alleviate edema and slow scar tissue formation. Surgical excision of scar tissue from the dorsum of the nose can repair the pollybeak deformity. Surgical correction of a supratip fullness that causes a disparity between the tip and supratip is known as a "pollybeak deformity". The appearance of the nose in some individuals with pollybeak deformity can resemble that of a bird, which can cause them to feel self-conscious and embarrassed. Therefore, treatment with medicine or surgery is required for these ailments.

Osteotomies and Dorsal Hump Reduction in Rhinoplasty: Review of Techniques and Complications

Osteotomies and Dorsal Hump Reduction in Rhinoplasty: Review of Techniques and Complications

Efficiency of Middle Vault Reconstruction with Dorsal Septal T Flap in Achieving Ideal Dorsal Aesthetic Lines and Regularity.

Dorsal aesthetic lines and irregularities are the most critical points that can be manipulated in rhinoplasty operations. Although spreader grafts and flaps have been used for this purpose in the reconstruction of the keystone area for a long time, dorsal irregularity is often inevitable. This study aims to evaluate the effectiveness of dorsal septal T flap and nasal dorsum reconstruction in achieving ideal dorsal aesthetic lines and regularity. Thirty-four patients (30 women, 4 men) who underwent closed technique rhinoplasty between 2019 and 2021 were included in the study. The mean age of the patients was 25.4 years. Patients with crooked nose, severe deviation, and severe dorsal hump were also excluded. All patients included in the study underwent Rhinoplasty Outcome Evaluation (ROE) questionnaires preoperative and postoperative 1st year. The mean age of the patients was 25.4 years (range 18-40years). A total of 34 patients, including 30 women and four men, were operated. The mean follow-up period was 13.2 months, ranging from 12 to 14months. In the physical examinations performed at the control visits, no functional problem was encountered in any patients. Preoperative and postoperative mean ROE scores were 60.9 and 92.7, respectively. With the technique described in the study, dorsal hump recurrence is minimized compared to other preservation techniques. Since the keystone area transition can be fine-tuned, continuity is ensured, and ideal dorsal aesthetic lines are created. The stability of the upper lateral cartilages is provided, thus eliminating the need for spreader grafts. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Partial Release of Pyriform Ligament to Prevent Deformities on Keystone Area.

The dorsal hump deformity is common among Western countries based on the nasal structure of Caucasians. Dorsal preservation techniques which leads keeping the keystone area intact can bring positive outcomes such as obtaining aesthetic dorsal lines and better functional results. The positions of soft tissue in the face are supported with a combination of static and dynamic ansatomy. The static support is maintained by ligaments and their associations. Among the ligaments, the pyriform ligament takes a particular role in terms of supporting the alar base, lower lateral cartilages, and nasal tip. In the present research, it was aimed to investigate the beneficial effects of releasing pyriform ligament partially in patients who received dorsal preservation rhinoplasty. The data of the patients who had dorsal rhinoplasty operations for hump deformity were screened retrospectively. A total of 139 patients were included according to inclusion and exclusion criteria and their records were assessed (112 females and 27 males). Twelve months after surgery, the median Rhinoplasty Outcome Evaluation score increased from 52.5 to 91.5 points ( P <0.001). Patient satisfaction was excellent in 86.95% of the included cases according to the Rhinoplasty Outcome Evaluation score. The present study shows a new, suitable, and easy approach for releasing the pyriform ligaments partially and as well as also were left intact. It is suggested that manipulation of the pyriform ligament during push-down and let-down procedures seems to be essential for obtaining a better nasal tip as well as narrowing the nose base and getting better functional outcomes.

Semidorsal Preservation Techniques With Ostectomy for Narrowing the Nasal Roof.

Dorsal hump deformity is prevalent in Caucasians because of their nasal structure. The dorsal preservation techniques became more popular in recent years. However, there is still not a clear solution for patients who have nasal hump deformity and a wide nasal roof. The present study aims defining a new technique that combines push-down or let-down procedures with ostectomy in patients who have nasal hump deformity and a wide nasal roof. In the present research, the records of patients were assessed retrospectively. The patients who had nasal hump deformity and who have undergone either push-down or let-down approaches were included. The push-down or let-down techniques used in this study involved ostectomy to reduce the nasal hump and narrow the nasal roof. The initial median Rhinoplasty Outcome Evaluation score before surgery was 57.5, which significantly improved to 93.00 points at 12 months after surgery ( P <0.001). The study suggests that experienced surgeons using push-down and let-down techniques can achieve better esthetic results in patients with a wide nasal roof.

Non-surgical rhinoplasty using polydioxanone threads.

To demonstrate the effects of PDO threads non-surgical rhinoplasty on patients' quality of life (using FACE-Q Scale) and first impression assessments. This is a prospective cohort study of 10 adult patients who sought non surgical rhinoplasty to improve tip rotation or reduce the appearance of a dorsal hump. All patients fulfilled the study's enrollment criteria. Prior to treatment, patients completed pre-treatment FACE-Q surveys and pre-treatment photos were obtained. Each patient was treated with the appropriate size and number of PDO threads necessary to achieve optimal correction result (OCR). Two weeks after treatment, the patient completed posttreatment FACE-Q surveys and posttreatment photos were obtained and analyzed. First impression surveys were created using pre- and posttreatment photos, and the survey was completed by 146 blinded evaluators. There was statistically significant improvement in the FACE-Q scores for social function (p = 0.02), psychological function (p = 0.0009) and satisfaction with nose (p = 0.0001). There was significant reduction in scores for appearance related psychosocial distress (p = 0.03). For the first impression surveys, there was a statistically significant improvement (p = 0.029) in the attractiveness scale posttreatment. Although not statistically significant, there was reduction of the dorsal hump (p = 0.15) and increase in the nasolabial angle (p = 0.48) and Goode's ratio (p = 0.16). There were no major adverse events or complications. This study shows that the PDO threads alone can be used safely to achieve minor nasal changes especially in tip rotation and appearance of dorsal hump, to improve patients' quality of life, and perceived attractiveness of treated patients.

Common Dorsal Flaws Following Preservation Rhinoplasty: A Systemic Analysis.

There has recently been a resurgence of interest in preservation rhinoplasty (PR) for dorsal hump elimination or dorsal projection reduction. However, no studies have scrutinized aesthetic outcomes to identify common pattern of flaws seen in published images to aid those with ardent enthusiasm for this technique to become aware of the frequency of these flaws and find ways to reduce imperfections. A systematic literature review was performed using search terms ("preservation" OR "let down", "push down") AND "rhinoplasty" on PubMed, Cochrane, SCOPUS, and EMBASE databases for studies between January 2000 and December 2022. Patient images from these studies were analyzed by three reviewers (MWW, IAC, and BG) for dorsal flaws. Raw interrater agreement percentage and Krippendorff's alpha were calculated to determine interrater reliability. A descriptive and comparative analysis with Fisher's exact test was performed for the aggregate data. There were 59 patient images with 464 views from 24 studies included for final analysis. Optimal dorsal aesthetic lines (DAL) were noted in 12 patients (20.3%), while optimal profile was observed in 15 patients (25.4%) (p=0.66). Combined ideal front and profile view of dorsum was not observed on any patients. The most common flaws were DAL irregularities (n=45; 78.0%), dorsal deviation (n=32, 54.2%), and residual hump (n=25, 42.4%). There was excellent interrater agreement. While PR may have some advantages, it has shortcomings in outcomes, particularly dorsal irregularities, dorsal deviation, and residual humps. Awareness of these imperfections may compel those performing this procedure to modify their techniques and improve their results. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Exploring the Resurgence of the Preservation Rhinoplasty: A Systematic Literature Review.

The underlying principles of preservation rhinoplasty (PR) center around maintaining the soft tissue envelope, dorsum, and alar cartilage through surgical manipulations and tip suture techniques. In particular, the let-down (LD) and push-down (PD) techniques have been described, although reports of indications and outcomes in the literature are sparse. A systematic review of the literature was performed using search terms "preservation" OR "let down" OR "push down" AND "rhinoplasty" on PubMed, Cochrane, SCOPUS, and EMBASE databases. Patient demographic information, operative details, and surgical outcomes were recorded. Sub-cohorts for patients who underwent LD and PD techniques were analyzed utilizing Fischer's exact test for categorical variables and Student's t test for continuous variables. Overall, there were 5967 PR patients in 30 studies in the final analysis, with 307 patients in the PD cohort and 529 patients in the LD cohort. The Rhinoplasty Outcome Evaluation Questionnaire showed a significant increase of patient satisfaction after PR compared to before PR (62.13 vs 91.14; p < 0.001). There was a significantly lower rate of residual dorsal hump or recurrence of 1.3% (n = 4) in the PD when compared to 4.6% (n = 23) in LD cohorts (p = 0.02). The revision rate of PD (0%, n = 0) was also significantly lower than that of LD (5.0%, n = 25) (p < 0.001). Based on these published articles, it seems that preservation rhinoplasty is safe and efficacious procedure with improved dorsal aesthetic lines, reduced dorsal contour irregularities, and claimed excellent patient satisfaction. In particular, the PD technique has fewer reported complications and revisions than LD approach, although PD is often indicated in patients with smaller dorsal humps. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .