Dorsal Preservation Shows Early Aesthetic Gains Over Conventional Rhinoplasty

Rhinoplasty remains one of the most frequently performed aesthetic procedures, yet the risk of functional impairment or secondary deformity necessitates precise surgical planning to minimize postoperative harms [1]. Traditional techniques involving the resection of the osseocartilaginous vault (the structural framework of the upper two-thirds of the nose) often require complex midvault reconstruction using spreader grafts or flaps to maintain the patency of the internal nasal valve, which is the narrowest segment of the airway regulating nasal resistance [2, 3]. While autologous cartilage remains the preferred material for these reconstructions, a meta-analysis of 1,233 patients demonstrated that autologous grafts significantly reduce complication rates (RR 0.34; 95% CI: 0.22, 0.52) compared to synthetic silicone prostheses [4]. The search for techniques that minimize structural disruption has led to a resurgence of interest in dorsal preservation, an approach that aims to maintain the integrity of the nasal keystone (the critical junction of the nasal bones and upper lateral cartilages) by repositioning rather than resecting the dorsal anatomy [5, 6]. Recent systematic data indicate that specific preservation methods, such as the spare roof and let-down techniques, provide a mean internal nasal valve angle improvement of 1.43 degrees (p = 0.02), suggesting these methods are functionally viable alternatives to traditional resection [7]. Building on this foundation, a new longitudinal analysis compares the patient-reported outcomes of these two distinct surgical philosophies over a multi-year period to guide clinical decision-making.