Strategic Decision-Making in Preservation Rhinoplasty: Key Considerations for Optimal Outcomes.

Aim and background:  Candidacy for dorsal preservation rhinoplasty (DPR) techniques is determined by a combination of preoperative nasal analysis and intraoperative assessment of the bony vault and septum. Classic ideal candidates have a pleasing frontal aesthetic, shorter nasal bones, bony cap at or cephalic to the rhinion, straight and appropriately narrow dorsal aesthetic lines (DALs), and a small to medium-sized hump.

Current and future development:  Alongside the growing popularity of DPR in recent years there have been numerous new methods described for approaching the bony vault and septum that expand both the definition of dorsal preservation and its potential indications. These techniques expand DPR candidacy to the crooked nose, S-shaped hump, wide or irregular DALs, and deviated caudal septum.

Conclusion and clinical relevance:  The decision toward choosing a dorsal preservation approach is nuanced, surgeon-dependent, and may be less obvious with these new modifications. Classical or modified DPR, when executed well in appropriate candidates, is an excellent method to achieve a natural reduction of the dorsal profile.