Aspects and Concepts of What I Preserve in Rhinoplasty: Proceedings of the 2025 American Society of Plastic Surgeons Spring Meeting.

Despite increasing national rhinoplasty rates, plastic surgeons' share of these procedures may be changing, and rhinoplasty remains one of the most difficult procedures to teach residents. In part, among many factors, any lower adoption trends may be attributable to the multiple available challenging approaches and emerging philosophies in the field. For example, although preservation rhinoplasty has reemerged over the past decade in the rhinoplasty community, whether structural or preservation techniques achieve superior long-term cosmetic and functional outcomes remains operator dependent. During the American Society of Plastic Surgeons Spring Meeting in 2025, 4 senior rhinoplasty surgeons representing 115 practice years discussed their philosophies and approaches to rhinoplasty, focusing on the selective use of structural rhinoplasty versus preservation techniques, techniques, and graft choices to optimize nasal anatomy in three-dimensional planes; aligning surgeon and patient goals in the preoperative setting; and optimizing teachability of rhinoplasty to trainees. Their collective experience offers a framework for the selective introduction of certain preservation principles into a modern approach to rhinoplasty, with a focus on maintenance of functional nasal anatomy and teachability to the next generation of rhinoplasty surgeons.