Decision Making in Preservation Rhinoplasty: A 100 Case Series With One-Year Follow-Up

Abstract

Preservation Rhinoplasty (PR) is a new chapter in rhinoplasty history. The term was coined by Daniel in 2018 and represents a fundamental change in philosophy. To discuss a single surgeon case series utilizing PR techniques. One hundred fifty-three primary rhinoplasty cases were studied retrospectively between December 2016 and August 2017. One hundred cases had at least one year of follow-up. Technical details were recorded including dissection plane, ligament preservation, tip support, lateral crural maneuvers, alar contour grafts, and preservation of the dorsum versus traditional reduction. These 100 cases fall into 2 categories: (1) preservation rhinoplasty complete (PR-C); and (2) preservation rhinoplasty partial (PR-P). All patients had open rhinoplasty and the average follow-up time was 13 months. All patients had preservation of the dorsal soft tissue envelope, while 36 had preservation of the entire soft tissue envelope and ligaments. Fifty-four had preservation of the alar cartilages. Thirty-one had dorsal preservation. The combinations include: PR-Complete (skin, dorsum, and alars): 26; PR-Partial (skin and dorsum): 28; PR-Partial (alars and dorsum): 29; and PR-Partial (skin and alars): 21. Preservation rhinoplasty is a paradigm shift. In most patients, the dorsal soft tissue envelope and nasal ligaments can be preserved. When possible, the lateral crura should be preserved and tensioning chosen over excision. Dorsal preservation is a versatile technique with proper patient selection, and long-term issues with the middle vault and keystone area can be avoided. Some patients will benefit from total preservation where nothing is removed/disrupted and underlying structures are reshaped.