Journal archive · Preservation rhinoplasty · Rib, ear and septal grafts · Dorsum and hump · Septum, valve and airway · Cleft, trauma and reconstruction · Outcomes, satisfaction and psychology · 2024
Comparison of Functional and Cosmetic Outcomes Between Dorsal Preservation and Spreader Flap Rhinoplasty: A Randomized Trial
Zarei R, Most SP, Amali A, Saedi B.
What this paper says
In a randomised trial of 84 patients, dorsal preservation with a modified subdorsal strip and conventional hump resection with spreader flaps gave the same results at one year for residual hump, width, projection, rotation, satisfaction and SCHNOS scores.
Overview
This Tehran trial (with Stanford's Most as co-author) is one of the few randomised comparisons of preservation versus conventional hump reduction. Eighty-four rhinoplasty candidates were randomly assigned to hump resection with spreader-flap mid-vault reconstruction or to dorsal preservation with the modified subdorsal strip method. At one year, outcomes were assessed with SCHNOS, VAS and image analysis.
Sections of note
- 84 patients; mean age 30.96 (SD 6.75); 15 (17.6%) male; groups balanced on confounders.
- Residual hump: no difference (P = .11).
- Nasal width P = .37; projection P = .70; rotation P = .79.
- VAS P = .81; SCHNOS P = .90.
- Conclusion: outcomes "may be comparable."
What it means for a patient
- In the best-designed comparison available, neither technique gave better appearance or breathing at one year.
- Claims that preservation produces superior results are not supported by this trial.
- One year is short for judging hump recurrence, which can appear later.
Why this paper matters
It is a randomised trial in a field dominated by retrospective series, and it found equivalence. Limits: 84 patients, one-year follow-up, single centre, one variant of each technique.
Terms
- Randomised trial: patients assigned to treatments by chance to make groups comparable.
- Subdorsal strip: a strip of septal cartilage removed just below the bridge so the intact dorsum can drop.
- Spreader flap: the upper lateral cartilage folded inward to rebuild the middle vault after hump removal.
- Residual hump: a bump remaining after surgery.
- SCHNOS: a validated nasal outcome questionnaire.
Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows. All 1,262 summaries.
From the abstract
“Preservation rhinoplasty is a novel and increasingly utilized method in nasal plastic surgery. Objectives: The study aimed to compare the functional and aesthetic outcomes of dorsal preservation rhinoplasty, a new and interesting method, with conventional hump resection. Methods: A total of 84 rhinoplasty applicants…”
Excerpt; the full abstract is on PubMed.
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What the rhinoplasty literature says on this paper's topics, cited line by line to PubMed.
Preservation rhinoplasty
Preservation rhinoplasty lowers the hump by taking cartilage and bone out from underneath and letting the roof of the nose settle, instead of cutting the roof off and rebuilding it.
Rib, ear and septal grafts
Modern rhinoplasty builds rather than removes, so the operation runs on cartilage: the septum first, then the ear, then the rib, and when none of those will do, a piece of donated rib from a tissue bank.
Dorsum and hump
The hump is the commonest reason people ask for rhinoplasty and the step that decides most of what follows: take the roof off and the middle vault has to be rebuilt, keep the roof and it may push its way back up.
Septum, valve and airway
Every rhinoplasty is a breathing operation whether it intends to be or not: the septum holds the nose up as well as dividing it, and the narrowest part of the whole airway is the internal valve the surgeon is standing over.
Cleft, trauma and reconstruction
A cleft nose is a sequence spread across a childhood: a repair at three months, sometimes a second at five or six, and a definitive rhinoplasty once the face has finished growing.
Outcomes, satisfaction and psychology
Rhinoplasty is measured with ten different questionnaires, none of which covers both the way the nose looks and the way it breathes, and the best-developed one has no airway questions at all.
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