Trial, Error, and Expertise: My Evolution Through Structural and Preservation Rhinoplasty Techniques.

Rhinoplasty is a continuously evolving field, where meticulous surgical technique significantly impacts outcomes. This article reviews the author's experiences, explores remaining questions, and presents refinements aimed at improving consistency and predictability in rhinoplasty results. The author's rhinoplasty practice began with open structure techniques in 2004, transitioning to closed rhinoplasty with preservation principles over the past decade. Technical refinements have shaped modern approaches, emphasizing both dorsal reconstruction and preservation. Key anatomical considerations include the Pitanguy ligament, the WASA (junction of upper lateral cartilages' caudal border and anterior septal angle), and septal mucosa. Understanding these structures is critical for achieving predictable aesthetic and functional results. Patients with wide, asymmetric, or high-arched dorsums may benefit from structured techniques, while those with moderate hump dorsums and deviations are better suited for preservation approaches. Key technical refinements include controlled mucosal resection, careful selection of intercartilaginous incisions, and optimized tip suturing strategies. The adoption of subareolar dissection for tip surgery and the combination of subdomal grafts with neo-interdomal ligament sutures have enhanced outcomes. The evolution of rhinoplasty techniques, incorporating both structural and preservation elements, allows for more predictable and refined results. Ongoing refinements in dissection methods, suturing techniques, and mucosal management continue to shape the future of rhinoplasty, emphasizing a balance between function and aesthetics.