Journal archive · Preservation rhinoplasty · Septum, valve and airway · Outcomes, satisfaction and psychology · Anatomy and nasal analysis · 2026
Preservation rhinoplasty versus conventional structural reduction: a systematic review of aesthetic, functional, and patient-reported outcomes
Zadeh AZ, Naeini M, Geranfar A, Keshtan SB, Padash Y, Haddadian M, Barghani MRR, Adinevand E, Jahromi MK.
In the archive as a landmark paper: the core sweep runs 2011–2026, and this one is here because the history of rhinoplasty rests on it · cited on middle vault.
Abstract
Background: Dorsal preservation rhinoplasty aims to maintain the native dorsal roof while achieving aesthetic and functional goals comparable to structural dorsal hump reduction. This systematic review evaluates comparative outcomes, patient-reported measures, and complication patterns across techniques.
Methods: A systematic search of PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL was performed from inception to November 1, 2025. Eligible studies included randomized trials, comparative cohorts, and case series with ≥ 10 patients and ≥ 6 months of follow-up. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2 and ROBINS-I. Outcomes included validated PROs, objective airway metrics, aesthetic assessments, and complications.
Results: From 487 records identified, 20 studies met inclusion criteria. Across randomized and nonrandomized comparative studies, dorsal preservation demonstrated aesthetic and functional results equivalent to structural dorsal hump reduction at 6-12 months. Patient-reported improvement (ROE, NOSE, SCHNOS) was consistently favorable in both groups. The only comparative objective airway study showed no significant differences in cross-sectional area or nasal volume. Complication and revision rates were low overall, with pooled recurrence and revision typically between 2-4%.
Conclusion: Current evidence indicates that dorsal preservation rhinoplasty provides outcomes comparable to structural reduction in appropriately selected patients. Standardized reporting and more objective physiologic evaluations are needed.
Abstract as indexed by PubMed; the article is open access (PubMed Central).
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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.
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.
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.
Anatomy and nasal analysis
Before any technique is chosen, the nose has to be read: the bone measured, the cartilage counted, the skin assessed, and the result the patient wants agreed on a photograph that is not yet true.
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