Dorsal Preservation versus Conventional Hump Reduction Rhinoplasty: A Seven-Year Review of Patient Reported Outcomes and Concurrent Operative Techniques

Overview

Most's group retrospectively compared 178 dorsal preservation (DPR) and 199 conventional hump reduction (CHR) patients treated from 2017 to 2024. Outcomes were SCHNOS and VAS scores at baseline and 3, 6, 12 and 24 months, with regression adjusting for age, sex and baseline severity. They also tallied which adjunct techniques accompanied each approach.

Sections of note

• Unadjusted: DPR had better SCHNOS-C and VAS-C at 3 and 6 months, with modest absolute differences.
• Adjusted: DPR independently associated with better SCHNOS-C at 6 months only.
• No aesthetic difference at 12 or 24 months; no functional difference at any time.
• CHR patients more often had spreader grafts or autospreaders, anterior septal reconstruction and clocking sutures; DPR patients more often had supratip, radix and underlay articulated rim grafts.
• Level of Evidence 3; the authors call the findings associative, not causal.

What it means for a patient

• Preservation patients may look "done" slightly sooner, but by one year both groups rated their noses the same.
• Breathing results were identical between approaches in this large series.
• Each approach comes with its own set of add-on techniques; the choice depends on the nose, not the label.

Why this paper matters

It is one of the largest and longest patient-reported comparisons of the two philosophies, from a centre that does both. Limits: retrospective, non-randomised, and technique selection was driven by anatomy.

Terms

• SCHNOS-C / SCHNOS-O: the cosmetic and obstruction subscales of a validated nasal questionnaire.
• VAS-C: a visual analogue rating of appearance.
• Autospreader: the upper lateral cartilage folded inward to act as a spreader graft.
• Anterior septal reconstruction (ASR): rebuilding the front of the septum with grafts.
• Articulated rim graft: a cartilage strip along the nostril rim attached to the tip complex.