Preservation Versus Structural Reconstruction of the Cartilaginous Midvault: Can You Tell What Technique Was Done

Goals/Purpose: Dorsal preservation rhinoplasty (DPR) is one approach in the reemerging concept of preservation rhinoplasty. A more natural appearance may be obtained by preserving the osseocartilaginous dorsum compared to dorsal reconstruction techniques. As indications for DPR continue to expand and surgeons become increasingly familiar with DPR, it is only natural to begin comparing dorsal reconstruction with preservation. This study aims first to determine if it is possible to identify patients who underwent DPR. The secondary objective of this study is to compare the magnitude of change in appearance and how natural-appearing the post-operative results are between dorsal preservation versus dorsal reconstruction.

Methods/Technique: A total of 100 primary rhinoplasty cases performed by a single surgeon were included in this retrospective study. Three blinded, independent plastic surgeons evaluated fifty dorsal preservation and 50 non-preservation patients. Evaluators were presented pre- and post-operative photos in the frontal, dorsal, left and right oblique, and lateral views. The evaluator first identified whether the patient underwent dorsal preservation or dorsal reconstruction rhinoplasty. Next, the pre- and post-operative nose was rated using a 10-point Likert scale (0-very ugly; 10-very nice). Finally, each post-operative nose was assessed on how natural or unnatural it appeared.

Results/Complications: Dorsal preservation was correctly identified with an accuracy of 57.14%, while dorsal reconstruction was identified with an accuracy of 27.78%. The mean pre- and post-operative appearance scores for DP patients were 4.86 and 8.43, respectively, with a mean difference of 3.57. Non-preservation patients had a mean pre- and post-operative appearance score of 4.83 and 8.17, respectively, and a mean difference of 3.33. Those who underwent DP were rated to have a more natural-appearing post-operative nose with a mean of 89.00/100. Non-preservation patients had a mean natural appearance score of 87.11/100.

Conclusion: While long-term results of dorsal preservation will continue to be an area of interest and future studies, this study's aim is to determine whether there is a more optimal and natural appearing technique for dorsal reduction by comparing dorsal midvault preservation versus reconstruction in primary rhinoplasty patients performed by a single surgeon. We found that dorsal preservation is at least equivalent to reconstructive techniques and has the benefit of fewer cartilage requirements. It is a viable approach with good results that rhinoplasty surgeons should consider for their patients.