Dorsal Preservation Rhinoplasty Research Articles

Comparison of Nasal Airways After Classical Structural Rhinoplasty and Dorsal Preservation Rhinoplasty.

Purpose: To investigate whether there was a difference in the nasal airway dimensions after dorsal preservation and classical structural rhinoplasty. Introduction: The surgical approach to rhinoplasty has improved over many decades. The first was the classic structural rhinoplasty (CSR) developed by Joseph, where the excess tissues are removed from the dorsal hump. In the following decades, dorsal preservation rhinoplasty (DPR) was established to prevent complications associated with CSR. Methods: One hundred twenty-four patients without self-reported nose obstruction syndromes underwent DPR or CSR according to the authors' shared surgical regime. Nasal airway dimensions of rhinoplasty patients were measured preoperatively and postoperatively with acoustic rhinometry (AR), and minimum cross-sectional areas (MCA) and internal nasal volumes (VOL) were acquired. Results: Dorsal preservation rhinoplasty was performed on 64 patients (51.6%), while classical structural rhinoplasty was performed on the remaining 60 (48.4%). There were no significant differences between the 2 techniques regarding VOL and MCA. (MCA1left side DPR vs CSR P = .539, VOL1 right side DPR vs CSR P = .843). Conclusion: We postulate that nasal airway dimensions do not predict or indicate whether the DPR or CSR technique will be/have been used in rhinoplasty surgery, and the employed technique does not significantly alter the dimensions of the nasal airways. Any significant change in nasal airway dimensions is more likely due to the septal intervention.

Proximal Intact Spreader Graft in Let-Down Dorsal Preservation Rhinoplasty.

Grafts and flaps play significant roles in rhinoplasty procedures, while spreader grafts are commonly used. Spreader grafts are placed into submucosal pockets between the upper lateral cartilage and nasal septum. Occurrence of deviation can be seen on nondeviated noses after let-down or push-down methods are performed as the part of the upper septum that has been let-down may cause pressure on the lower septum and that results in deviation. In the present study, the author aimed to demonstrate the benefits of using a proximal intact spreader graft to support the nondeviated nasal septum or to correct the deviated septum in patients undergoing dorsal preservation rhinoplasty. In deviated noses, the upper septum is brought down to the opposite side of the deviation, and a proximal intact spreader graft is placed between the upper and lower septum to correct the deviation and make the dorsum nondeviated. This technique is suitable for patients with a slight to moderately deviated caudal part of the septum. It is unsuitable for patients with severe, cross, or S-shaped deviation. This technique aims to preserve the condition of the nondeviated nose and convert it into a nondeviated state in the let-down technique. The combination of proximal intact spreader graft and dorsal preservation rhinoplasty techniques effectively addresses dorsal hump and dorsal deviation deformities, enhances upper lateral cartilage concavity, prevents W-ASA segment collapse, and both prevents and improves internal nasal valve collapse. The data of patients who underwent dorsal hump reduction with the let-down technique were screened. According to inclusion and exclusion criteria, 95 patients were included in the study (68 females and 27 males). The ROE score before the operation was 51.5. After 12 months, it was found to be 91.5 points, and the change in the ROE median score was significant (P < 0.001). This new proximal intact spreader graft method presents a suitable approach for surgeons to prevent any let-down-induced deviation problems that may occur after the procedure and to correct the present deviation. It will also lead to better cosmetic and functional outcomes for patients who have hump deformity.

Dorsal Preservation Rhinoplasty-the Perspective of "Preservers" Versus "Structural" Surgeons.

The objective of this study was to describe the surgeons who have incorporated dorsal preservation (DP) into their practice and their techniques. An anonymous form reviewed by the Evidence-Based Rhinoplasty Research Group board was shared on its Telegram group. The study population was divided into three groups based on their answers: "Preservers," "Mainly Structural," and "Structural exclusively." This study included the answers of 145 worldwide surgeons. DP was more common among plastic surgeons than otolaryngologists/facial plastic surgeons; DP techniques were mostly preferred by surgeons with 10-20 years of experience, while structural techniques were mostly preferred by surgeons with > 20 years of experience; 50.8% of the surgeons who prefer DP techniques use it in more than 90% of primaries; surface techniques (ST) have been more used, mainly by surgeons who prefer structural techniques (p < 0.001). ST were considered more stable (p < 0.001), more predictable (p < 0.001), and shorter learning curve (p < 0.001). Many surgeons using DP still perform structural rhinoplasty. The most cited concern was hump persistence/recurrence. DP rhinoplasty is gaining acceptance, and ST are favored for their perceived short learning curve, stability, and predictability. However, concerns about hump recurrence cause some to continue using structural methods alongside DP.

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.

Dorsal Preservation Rhinoplasty Using a Ferreira-Nakamura Spare Roof Technique B Highlighting the Low Septal Cartilage Strip.

Dorsal preservation rhinoplasty techniques can be surface or foundation techniques and respect the philosophy of preserving the osteocartilaginous nasal vault. A spare roof technique (SRT) aims to preserve the upper lateral cartilages through surface techniques. In tension noses with considerable caudal septum deviations, the septal can be repositioned after a low strip of septal cartilage is removed, and the SRT-B is used to reduce the osteocartilaginous hump. This inclusion of the low septal cartilage strip in the SRT-B rhinoplasty is termed as SRT-B3 and builds upon the previously reported philosophy advocated in SRT-A and SRT-B. Correction of moderate deviations of the nasal axis and/or the caudal septum can be addressed with this modification.

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.

Modification of Low Septal Strip Septoplasty to Reduce Hump Recurrence in Dorsal Preservation Rhinoplasty.

Among the problems encountered in the dorsal preservation rhinoplasty technique are residual hump and hump recurrence. In our study we performed a modification to lower strip resection and the fixation of the septum. The clinical results of these modifications on hump recurrence were investigated. 231 patients who underwent dorsal preservation rhinoplasty with low septal strip septoplasty between November 2021 and February 2023 were included in the study. Closed dorsal preservation rhinoplasty was performed with low septal strip septoplasty in 31.2% (n=72) and modified low septal strip septoplasty technique in 68.8% (n=159) patients. All cases were primary rhinoplasty. Demographic data, complications, revision surgeries and follow-up periods of the patients were analyzed retrospectively. The mean follow-up period of the cases was 9.68±4.02 (3-16) months. Gender and age of the cases did not differ statistically significantly between the groups (p>0.05). Complications were observed in 3.5% of the patients (n=8/231). The complications in the low septal strip septoplasty group were statistically significantly higher than in the modified low septal strip septoplasty group (p=0.012; p<0.05). The incidence of recurrent hump complications in the low septal strip septoplasty group was statistically significantly higher than in the modified low septal strip septoplasty group (p=0.029; p<0.05). Septum fixation is one of the most important parts of the surgery in dorsal preservation rhinoplasty and must be done properly. In this modification that we described, the risk of recurrent hump is reduced, as sufficient septum fixation is achieved.

Tip Surgery in Dorsal Preservation Rhinoplasty: The Effect of Modified Low Septal Strip Septoplasty on Tip Plasty.

The aim in tip surgery is to provide rotation, derotation, projection and deprojection. In this study, we aimed to show the effects of modified low septal strip septoplasty, septal extension graft, TIG technique and additional maneuvers on tip shape in dorsal preservation rhinoplasty (DPR) and to discuss our clinical results. One hundred eighty-nine patients who underwent DPR with modified low septal strip septoplasty between November 2021 and August 2023 were included in the study. Demographic data, complications, revision surgeries and follow-up periods of the patients were analyzed retrospectively. The mean age of the patients is 29.58±9.04 (17-65). The mean follow-up period was 14, 50±2,98 months. Complications were observed in 1.1% of the patients (n=2/189). Revision surgery was performed in all these patients. Residual hump in 2 were observed and dorsum rasping was performed under local anesthesia. No tip revision was performed on any patient. A strong tip fixation is achieved with the modified low septal septoplasty technique described in this publication, and when combined with septal extension graft, tongue in groove technique and other suture techniques, an effective and permanent tip plasty can be performed in DPR. 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 .

Preservation Rhinoplasty by the Ones Who Do It: A Worldwide Survey.

Dorsal preservation (DP) rhinoplasty techniques, including surface techniques (STs) and foundation techniques (FTs) have garnered significant attention internationally over the past few years. The practice patterns and opinions from 117 of these surgeons were surveyed from a cohort of these surgeons who participate in an online Evidence-Based Rhinoplasty Research Group. The findings of the survey are merely a snapshot of the international rhinoplasty community's practices, yet did capture data from surgeons from a diverse geographic, years of experience, and training background. STs were most used for the bone changes, and the high-strip technique was preferred for the cartilaginous septal surgery. STs are mostly performed by younger surgeons (<10 years of experience), whereas FTs were more common in older surgeons (10-30 years of experience). STs were considered more stable (p < 0.001), more predictable (p < 0.001), and associate with a shorter learning curve (p = 0.015). Revision surgery rates were not different. Regarding why many surgeons using DP still perform structural rhinoplasty, the most cited concern was hump persistence/recurrence. In summary, among surgeons using DP rhinoplasty techniques, the majority perform DP in over half of their primary rhinoplasty surgeries, highlighting the importance of updating educational programs in medical training, conferences, and courses.

The Nasal Locator: An Innovative Instrument to Define the Exact Point of Osteotomy in Preservation or Structural Rhinoplasty.

One of the most common components of most dorsal preservation (DP) techniques is subdorsal septal excision. Whatever the instrument used for this procedure (piezoelectric, Rongeur, or long scissors), it is paramount to be able to determine the exact subdorsal point (SDoP) at which the osteotomy/ostectomy (or cartilage cut) has been reached. First, to avoid any unnecessary extension of the osteotomy that increases the risk of fracture spreading into the cribriform plate and a consequent cerebrospinal fluid leak; second, to be sure that the subdorsal cut is high enough and can be combined/unified with the planned radix osteotomy.In addition, transverse osteotomies are usually necessary in both preservation and structural rhinoplasties. Even though many surgeons are satisfied with their osteotomy lines, it sometimes proves difficult to be sure of their position, especially during a DP rhinoplasty when both the transverse lines have to go in the direction of the planned radix osteotomy.We have developed the Nasal Locator (NL) to precisely define various nasal points of interest, such as a subdorsal cut (cartilaginous or bony), or a transverse or medial osteotomy line. It ends in two tips. The lower tip is placed at the point we wish to determine (e.g., SDoP or a transverse osteotomy), while the upper tip is fixed a certain distance from it (in all three dimensions), showing its exact location.Our in-depth research of the literature and the market has not revealed any device similar in form and function to the NL.We have been using the NL for almost 2 years and are confident of its usefulness. It is easy to use, and practically no time is needed to become familiar with it. During surgery, it is needed for less than 30 seconds and is risk-free. It is fully sterilizable and can be used repeatedly.

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.

Comparison of Dorsal Preservation Rhinoplasty Techniques: Functional and Aesthetic Review of Subdorsal Septal Strip Methods.

Objective: To compare subdorsal strip excisions in patients undergoing dorsal preservation (DP) rhinoplasty using patient-related outcome measures (PROMS). Methods: Patients were treated from 2020 to 2022 using the modified subdorsal strip method (MSSM) or Z flap approach. A two-sample t-test determined whether there was a difference in functional and aesthetic scores using the NOSE, Sinonasal Outcome Test (SNOT-22), SCHNOS, and ESS scales. Results: Seventy-one primary rhinoplasty patients met inclusion criteria at 12 months with an average age of 23 years (62 female, 9 male), with 35 (49%) undergoing the MSSM technique, while 36 (51%) receiving the Z flap. PROMS at 1, 3, 6, and 12 months postoperatively were compared. The average preoperative and postoperative NOSE score was 9.36 and -4.4 (standard deviation [SD] 3.1, p < 0.001). The average preoperative SNOT-22 score was 23.9 and -16.4 (SD 10.2, p < 0.001). ESS scores was average was 6.2 and -1.6 (SD 3.2, p = 0.01). The average SCHNOS total, functional, and cosmetic scores were 27.6 (6-47), 8.2 (0-20) and 18.7 (0-37), respectively, and -5.7 (SD 8.2, p < 0.001), -5.73 (SD 6.24, p < 0.001), -18.1 (SD 9.7, p < 0.001). No significant complications were found and no difference in PROMs among groups. Conclusion: There was no difference in septal strip techniques as evaluated by PROMS.

Invited Commentary: "Comparison of Dorsal Preservation Rhinoplasty Techniques: Functional and Aesthetic Review of Subdorsal Septal Strip Methods" by Barrera.

Invited Commentary: "Comparison of Dorsal Preservation Rhinoplasty Techniques: Functional and Aesthetic Review of Subdorsal Septal Strip Methods" by Barrera.

Crowdsourced Assessment of Aesthetic Outcomes of Dorsal Preservation Rhinoplasty

Abstract Goals/Purpose The inherent subjectivity in evaluating aesthetic outcomes presents a unique challenge in assessing rhinoplasty. Crowdsourcing has provided a new metric for objective analysis. The authors designed a study to compare the aesthetic outcomes of dorsal preservation rhinoplasty versus structural rhinoplasty using a reliable and valid crowdsourcing platform. We aim to objectively quantify the relative aesthetic advantages of performing a dorsal preservation technique. Additionally, we aim to demonstrate the efficacy of using crowdsourcing as an efficient and reliable method for evaluating any plastic surgery aesthetic outcome. Methods/Technique This retrospective observational study was approved by the IRB at UCLA. A total of 64 patients who had previously undergone rhinoplasty performed by the senior author were included. All surgeries were performed at the UCLA Ronald Reagan Medical Center. Patients with prior nasal surgery or trauma were excluded. All subjects were photographed using standard rhinoplasty views during the pre-and postoperative visits. Frontal and right profile photographs were then cropped in a standardized fashion (Photos, Version 8.0, Apple Inc.) and used for evaluation. All evaluations and ratings were collected using the HIPPA compliant and encrypted software via a secure online platform (LoveMyDelta, Inc., Philadelphia, PA). All crowd workers were recruited and vetted through this platform, with internal fidelity checks performed. Each crowd worker was shown a profile and frontal view of a patient and asked to score the overall appearance of the nose, the nasal dorsum profile, the symmetry of the dorsal aesthetic lines, and the dorsal contour using a visual analog scale. Scoring was performed using a provided validated visual assessment guide. They were asked whether they believed the subject had undergone rhinoplasty and asked to provide a level of confidence in their guess. Crowdworkers’ responses were aggregated to allow for high-powered intra-rater analysis. Intra-rater reliability and confidence intervals were calculated. Aggregate data from all raters were used to generate an absolute value of aesthetic state for each cohort. A "delta" was then obtained for each value by comparing the preoperative to the postoperative state to obtain a representative value of the improvement after undergoing surgery. Raters were asked if the patient appeared to have had surgery, and each correct and incorrect response was proportionally weighted based on the raters' confidence in their answer. The delta (difference in preoperative to postoperative aesthetic state) for each parameter for the dorsal and non-dorsal preservation cohorts was calculated using non-paired T-tests to determine significance. Results/Complications A total of 64 patients were included for evaluation. The structural rhinoplasty cohort consisted of 34 patients. The dorsal preservation cohort included 30 patients. Both dorsal preservation and non-dorsal preservation rhinoplasty cohorts were associated with improved overall crowdsourced aesthetic outcomes and improved outcomes across all subparameters. Overall, delta (d) improved in both dorsal preservation (0.300, 95% CI +/- 0.047) and structural (0.377, 95% CI +/- 0.055) cohorts. When raters were asked to predict whether a patient had surgery, the correlation coefficient between the confidence in the prediction and that prediction being correct was 0.74 (95% CI +/- 0.47 in the structural group, suggesting that a crowd worker was likely to be correct in identifying whether a patient had structural rhinoplasty. However, the correlation coefficient was -0.0554 (95% CI +/- 0.058) in the dorsal preservation group. This suggests the raters were unable to consistently identify which patients had dorsal preservation rhinoplasty with any confidence. Conclusion In the ongoing challenge to achieve better aesthetic outcomes in plastic surgery, crowdsourcing is a valuable tool for helping to measure these outcomes. We compared the aesthetic outcomes of dorsal preservation rhinoplasty versus structural rhinoplasty using a reliable and valid crowdsourcing platform. We found that significant improvements in overall aesthetic outcomes were achieved with both techniques, while a more natural “unoperated” outcome was achieved when performing a dorsal preservation technique. With this type of study and assessment tool, we helped to demonstrate the efficacy of using crowdsourcing as an efficient and reliable method for evaluating any plastic surgery aesthetic outcome.

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.

Simplified Septal Stabilization in Closed-Approach Low-Septal-Resection Dorsal Preservation Rhinoplasty

Background Septal fixation is a basic step in low-septal-resection dorsal preservation rhinoplasty. Inadequate septal stabilization can lead to supratip depression or more severe saddle nose deformity. This paper presents a simple surgical maneuver to stabilize quadrangular septal cartilage instead of suture fixation to the anterior nasal spine. Methods Thirty patients who underwent closed-approach low-septal-resection dorsal preservation rhinoplasty between July and December 2021 were included in this retrospective study. Depending on the surgical maneuver performed to stabilize quadrangular septal cartilage, the patients were divided into 2 groups as follows: (1) a group in which the septum was stabilized with transfixion sutures (the transfixion suture group) and (2) a group in which the septum was fixed to the anterior nasal spine with suture (the anterior nasal spine suture fixation group). Standardized postoperative 12-month lateral-view photographs were scanned for the presence of supratip depression or saddle nose deformity that may indicate insufficient septum stabilization. Results Supratip depression was observed in 1 patient in the transfixion suture group (n = 16) and in 1 patient in the anterior nasal spine suture fixation group (n = 14; P &gt; 0.05). No saddle nose deformity was observed in either group. Conclusions Transfixion sutures seem effective in providing septal stabilization to prevent supratip depression or saddle nose deformity in closed-approach low-septal-resection dorsal preservation rhinoplasty. Transfixion sutures can be used for septal stabilization in closed-approach rhinoplasty, allowing the surgeon to take advantage of the ease of placement.

Lateral Crural Turn-Up Flap for Increasing the Volume of Cartilaginous Nasal Sidewall in Closed-Approach Dorsal Preservation Rhinoplasty.

Dorsal preservation rhinoplasty can also be applied in crooked nose cases. This article describes a lower lateral cartilage-based flap (lateral crural turn-up flap) used to correct cartilaginous nasal sidewall asymmetries. It was aimed to introduce a flap to be used in crooked nose cases operated with dorsal preservation rhinoplasty and to show possible modifications of this flap. Eight patients who had lateral crural turn-up flap due to crooked nose between July and December 2021 were included in this retrospective study. Standardized preoperative and postoperative 12-month front-view photographs were analyzed and scored for correction of midvault nasal sidewall asymmetries by 2 plastic surgeons. The Rhinoplasty Outcome Evaluation (ROE) scale was applied at 12 months. The mean score given by the surgeons for correction of midvault nasal sidewall asymmetries was 4.18. The mean ROE score was 89, and all patients were satisfied according to their ROE scores. There were no major complications. Unilateral lateral crural turn-up flap seems to be effective in correcting cartilaginous nasal sidewall asymmetries in crooked nose cases operated with dorsal preservation rhinoplasty.

Let-Down Rhinoplasty in Patients With Cleft Lip Nose.

Rhinoplasty in patients with cleft lip nose (CLN) deformity is challenging. Cleft lip nose deformity primarily affects the nasal tip, columella, nostrils, alar base, floor, and septum. The needs of patients with CLN are quite different from those of patients who undergo primary rhinoplasty. Recently, the dorsal preservation rhinoplasty technique has gained popularity. We applied this technique to patients with CLN deformity to obtain better aesthetic and functional results. Ten consecutive patients with indication for primary CLN reconstruction underwent let-down rhinoplasty. Rhinoplasties were performed using either the closed or open approach, with costal cartilage grafts and full-thickness skin grafts. A rhinoplasty outcome evaluation questionnaire was used to assess the results. Moreover, the use of the same questionnaire in prior patients allowed us to compare results between our previous and new techniques. The study included 6 female and 4 male patients, with ages ranging from 18 to 25 years. Only 1 patient had a history of bilateral cleft lip. Seven patients had a history of left-sided cleft lip, and 2 patients had right-sided cleft lip. Open-approach let-down rhinoplasty with costal cartilage grafts and full-thickness skin grafts was performed in 8 patients, whereas closed-approach let-down rhinoplasty with costal cartilage grafts was performed in 2 patients. Columellar struts and affected-side onlay costal cartilage grafts were used in all patients. All patients reported being satisfied with the let-down rhinoplasty outcome, and none complained of functional problems. However, nostril symmetry was not observed in some patients, particularly in patients who underwent closed-approach rhinoplasty. Combining open approach, full-thickness skin graft, costal cartilage graft, and let-down rhinoplasty shows promising and satisfactory outcomes in patients with CLN. However, further studies are required to confirm this observation.

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.