Dorsal Preservation versus Open Structural Rhinoplasty: Can We Tell the Difference Between Aesthetic and Functional Outcomes?

Abstract

Purpose: Preservation - with respect to the dorsum, nasal cartilages, and soft tissue envelope - has re-emerged as a guiding philosophy in rhinoplasty. Dorsal preservation (DP) is attractive to its advantages of maintaining the osseocartilaginous construct and avoiding an open roof deformity. While several studies have suggested comparable outcomes of DP relative to structural rhinoplasty, it remains unclear how aesthetic, functional, and patient-reported outcome measures may compare, and also whether surgeons can discern differences between cohorts.

Methods: A retrospective review of patients undergoing dorsal preservation and structural rhinoplasty were included. Pre- and post-operative photographs at one year were included. Patients were classified into two cohorts - DP versus non-dorsal preservation (NDP). There were three types of raters - the general population (GP), plastic surgeons (PS), and rhinoplasty surgeons (RS). Patients were also asked to fill out questionnaires, including Rhinoplasty Outcomes Evaluation (ROE) and Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS).

Results: 78 subjects were included within the analysis. Overall, the evaluators correctly identified the surgical approach 52.9% of the time. Rhinoplasty surgeons demonstrated the least inter-rater variability, when compared to the general population and plastic surgeons. From the ROE and SCHNOS questionnaire, the overall mean (SD) obstruction composite scores was comparable between DP and NDP cohorts.

Conclusion: Across evaluators, there were comparable functional, aesthetic, and patient-reported outcomes between DP and NDP cohorts. Given its key advantage of ensuring the stability of the osseocartilaginous framework, DP should be performed for appropriate patients given its favorable aesthetic and functional outcomes.