Expanding Indications for Dorsal Preservation Rhinoplasty With Cartilage Conversion Techniques.

[BACKGROUND] Preservation rhinoplasty (PR) is a new and evolving philosophy in rhinoplasty surgery. As a surgeon becomes more experienced with preservation concepts, he/she begins to look for new ways to apply PR to an increasing percentage of primary cases.

[OBJECTIVES] This article presents a series of 100 primary rhinoplasties that underwent dorsal preservation with an emphasis on the cartilage-only dorsal preservation.

[METHODS] A total of 226 primary rhinoplasty cases were studied retrospectively between July 2017 and August 2018. One hundred cases of dorsal preservation were included in the study. Data was collected in all cases regarding age, gender, ethnicity, and technical details of the operation. These 100 cases fall into the following 3 categories: (1) dorsal preservation employing a subdorsal strip; (2) dorsal preservation utilizing a cartilage-only pushdown with separate bony pyramid modification; and (3) dorsal preservation employing a cartilage reduction method with separate bony pyramid modification.

[RESULTS] Fifty-seven patients underwent subdorsal strip technique, 39 underwent cartilage-only pushdown technique, and 4 underwent cartilage modification. The average lowering was 4.5 mm (range, 2-10 mm), 2.5 mm (range, 1-3.5 mm), and 2 mm (range, 1-2.5 mm) for the subdorsal strip, cartilage-only pushdown techniques, and cartilage modification technique, respectively. No patients required revision surgery of their dorsum.

[CONCLUSIONS] PR is a paradigm shift in rhinoplasty. With time, surgeons will find themselves asking in every situation whether they can preserve structures. Dorsal preservation is a reliable technique if patients are chosen properly. With bony cap modification, more dorsums can be preserved and dorsal aesthetics can be improved.