Dorsal Preservation versus Open Structural Rhinoplasty: Can We Tell the Difference between Aesthetic and Functional Outcomes?

Background: Preservation-with respect to the dorsum, nasal cartilages, and soft-tissue envelope-has reemerged as a guiding philosophy in rhinoplasty. Dorsal preservation (DP) is attractive for its advantages of maintaining the osseocartilaginous construct and avoiding an open-roof deformity. Several studies have suggested comparable outcomes of DP relative to structural rhinoplasty, but how aesthetic, functional, and patient-reported outcome measures may compare, and whether surgeons can discern differences between cohorts, remains unclear.

Methods: A retrospective review was performed of patients undergoing DP and structural rhinoplasty. Preoperative and 1-year postoperative photographs were taken. Patients were classified into 2 cohorts: DP or non-DP (NDP). There were 3 types of raters: the general population, plastic surgeons, and rhinoplasty surgeons. Patients were also asked to fill out questionnaires, including the Rhinoplasty Outcomes Evaluation and the Standardized Cosmesis and Health Nasal Outcomes Survey.

Results: A total of 78 participants were included within the analysis. Overall, the evaluators correctly identified the surgical approach 52.9% of the time. Rhinoplasty surgeons demonstrated the least interrater variability when compared with the general population and plastic surgeons. Overall mean obstruction composite scores from the Rhinoplasty Outcomes Evaluation and Standardized Cosmesis and Health Nasal Outcomes Survey questionnaire were comparable between DP and NDP cohorts.

Conclusions: Across evaluators, there were comparable functional, aesthetic, and patient-reported outcomes between DP and NDP cohorts. Given its key advantage of ensuring the stability of the osseocartilaginous framework, DP should be performed for appropriate patients given its favorable aesthetic and functional outcomes.

Clinical Question/level Of Evidence: Therapeutic, III.