Reduction Rhinoplasty's Bad Wrap—Is it Time to Forgive and Forget?... Or at Least Get a Rebrand?

Abstract

Aims and Backgrounds

Destigmatizing reduction rhinoplasty in a structural preservation era.

Historical Aspects

Transition from the classic Joseph rhinoplasty to modern emphasis on structural preservation has imparted negative connotations to the term reduction.

Anatomy

Anatomic features that predispose patients to functional compromise must be recognized and addressed in all approaches to ensure successful surgical outcomes.

Technology

Piezo ultrasonic instruments provide a safe and precise way to reduce the bony framework and can be applied to all styles of rhinoplasty.

Patient Selection

Patients with no concomitant functional issues, reasonable and conservative cosmetic expectations, and strong cartilage framework, who are managed by a thoughtful surgeon can expect excellent results regardless of the approach.

Techniques

Reduction rhinoplasty techniques are some of the most enduring in rhinoplasty and safe limits are described.

Postoperative Care

Patients should be followed for functional and/or quality of life performance.

Current and Future Development

Precision recommendations regarding thresholds for resection and grafting, as well as standardized preoperative evaluation methods are required.

Conclusion and Clinical Relevance

Rhinoplasty techniques exist in a continuum as do features of the nose. A one-style-fits-all approach is not appropriate and leads to avoidable postoperative failures and revision surgery. Reduction rhinoplasty may not be the “buzz” but it still has a place in contemporary conservative cosmetic surgery.

Keywords

reduction rhinoplasty - cosmetic rhinoplasty - re-branding

Publication History

Article published online:
27 May 2025

• References

• 1 Sylaidis P. Reduction rhinoplasty re-endorsed: when conservative and measured. JPRAS Open 2021; 30: 53-60
• 2 Adamson P, Smith O, Cole P. The effect of cosmetic rhinoplasty on nasal patency. Laryngoscope 1990; 100 (04) 357-359
• 3 Celebi S, Caglar E, Yilmaz B. et al. Does rhinoplasty reduce nasal patency?. Ann Otol Rhinol Laryngol 2014; 123 (10) 701-704
• 4 Arima LM, Velasco LC, Tiago RSL. Avaliação de resultados em rinoplastia de redução. Arq Int Otorrinolaringol 2011; 15 (01) 79-83
• 5 Grymer LF. Reduction rhinoplasty and nasal patency: change in the cross-sectional area of the nose evaluated by acoustic rhinometry. Laryngoscope 1995; 105 (4 Pt 1): 429-431
• 6 Gassner HG, Ordonez F, Nunes R. The limits of evidence in rhinoplasty. Facial Plast Surg 2023; 39 (04) 327-332
• 7 Patel PN, Kandathil CK, Abdelhamid AS, Buba CM, Most SP. Matched cohort comparison of dorsal preservation and conventional hump resection rhinoplasty. Aesthetic Plast Surg 2023; 47 (03) 1119-1129
• 8 Saban Y, Daniel RK, Polselli R, Trapasso M, Palhazi P. Dorsal preservation: the push down technique reassessed. Aesthet Surg J 2018; 38 (02) 117-131
• 9 Lee J, Abdul-Hamed S, Kazei D, Toriumi D, Lin SJ. The first descriptions of dorsal preservation rhinoplasty in the 19th and early- to mid-20th centuries and relevance today. Ear Nose Throat J 2021; 100 (10) 713-719
• 10 Patel PN, Kandathil CK, Buba CM. et al. Global practice patterns of dorsal preservation rhinoplasty. Facial Plast Surg Aesthet Med 2022; 24 (03) 171-177
• 11 Friedman O, Cekic E, Gunel C. Functional rhinoplasty. Facial Plast Surg Clin North Am 2017; 25 (02) 195-199
• 12 Behrbohm H, Briedigkeit W, Kaschke O. Jacques Joseph: father of modern facial plastic surgery. Arch Facial Plast Surg 2008; 10 (05) 300-303
• 13 Roe JO. The deformity termed “pug nose” and its correction by a simple operation. By John Orlando Roe, 1887. Arch Otolaryngol Head Neck Surg 1989; 115 (02) 156-157
• 14 Joseph J. Rhinoplasty and Facial Plastic Surgery: With a Supplement on Mammaplasty and Other Operations in the Field of Plastic Surgery of the Body: An Atlas and Textbook. Columella Press; 1987. . Accessed at: https://books.google.ca/books?id=sgzA3opK1D8C
• 15 Daniel RK, Sajadian A. Secondary rhinoplasty: management of the overresected dorsum. Facial Plast Surg 2012; 28 (04) 417-426
• 16 Spataro E, Piccirillo JF, Kallogjeri D, Branham GH, Desai SC. Revision rates and risk factors of 175 842 patients undergoing septorhinoplasty. JAMA Facial Plast Surg 2016; 18 (03) 212-219
• 17 Toriumi DM. Structure Rhinoplasty: Lessons Learned in 30 Years. DMT Solutions; 2019
• 18 Hahn S, Becker DG. What are some tips and pearls for preserving and improving nasal function when performing a cosmetic rhinoplasty?. Curr Opin Otolaryngol Head Neck Surg 2014; 22 (01) 58-62
• 19 Zhang K, Deane EC, Becker DG. Persistent cosmetic dissatisfaction in rhinoplasty & management of the difficult patient. Plast Aesthet Res 2024; 11: 23
• 20 Skoog T. Plastic Surgery: New Methods and Refinements. Almqvist & Wiksell; 1974. . Accessed at: https://books.google.ca/books?id=fAOXNgAACAAJ
• 21 Rohrich RJ, Muzaffar AR, Janis JE. Component dorsal hump reduction: the importance of maintaining dorsal aesthetic lines in rhinoplasty. Plast Reconstr Surg 2004; 114 (05) 1298-1308 , discussion 1309–1312
• 22 Alsakka MA, ElBestar M, Gharib FM, El-Antably AS, Al-Sebeih KH. Dorsal preservation rhinoplasty versus dorsal hump reduction: a randomized prospective study, functional and aesthetic outcomes. Eur Arch Otorhinolaryngol 2024; 281 (07) 3655-3669
• 23 Foppiani JA, Joy N, Hernandez Alvarez A. et al. Dorsal preservation versus component dorsal hump reduction rhinoplasty: an assessment of patient-reported outcomes. Plast Reconstr Surg Glob Open 2024; 12 (08) e6103
• 24 Fomon S, Gilbert JG, Caron AL, Segal S. Collapsed ala: pathologic physiology and management. Arch Otolaryngol 1950; 51 (04) 465-484
• 25 Oneal RM, Berkowitz RL. Upper lateral cartilage spreader flaps in rhinoplasty. Aesthet Surg J 1998; 18 (05) 370-371
• 26 Joseph J. The classic reprint: nasal reductions. Plast Reconstr Surg 1971; 47 (01) 79-83
• 27 Webster RC, Davidson TM, Smith RC. Curved lateral osteotomy for airway protection in rhinoplasty. Arch Otolaryngol 1977; 103 (08) 454-458
• 28 Kamburoglu HO, Bitik O, Vargel İ. Airflow considerations and the effect of Webster's triangle in reduction rhinoplasty. Aesthetic Plast Surg 2021; 45 (05) 2244-2254
• 29 Tardy M, Denneny J. Micro-osteotomies in rhinoplasty—a technical refinement. Facial Plast Surg 1984; 1 (02) 137-145
• 30 Ponsky D, Eshraghi Y, Guyuron B. The frequency of surgical maneuvers during open rhinoplasty. Plast Reconstr Surg 2010; 126 (01) 240-244
• 31 Gerbault O, Daniel RK, Kosins AM. The role of piezoelectric instrumentation in rhinoplasty surgery. Aesthet Surg J 2016; 36 (01) 21-34
• 32 Khajuria A, Krzak AM, Reddy RK, Lai K, Wignakumar T, Rohrich RJ. Piezoelectric osteotomy versus conventional osteotomy in rhinoplasty: a systematic review and meta-analysis. Plast Reconstr Surg Glob Open 2022; 10 (11) e4673
• 33 Gassner HG, Magdum AA, Tasman AJ. Minimally invasive techniques in rhinoplasty. Curr Opin Otolaryngol Head Neck Surg 2020; 28 (04) 218-227
• 34 Kisel J, Khatib M, Cavale N. A comparison between piezosurgery and conventional osteotomies in rhinoplasty on post-operative oedema and ecchymosis: a systematic review. Aesthetic Plast Surg 2023; 47 (03) 1144-1154
• 35 Aymard JL. Some new points on the anatomy of the nasal septum, and their surgical significance. J Anat 1917; 51 (Pt 3): 293-303
• 36 Rudy S, Moubayed SP, Most SP. Midvault reconstruction in primary rhinoplasty. Facial Plast Surg 2017; 33 (02) 133-138
• 37 Gruber RP, Park E, Newman J, Berkowitz L, Oneal R. The spreader flap in primary rhinoplasty. Plast Reconstr Surg 2007; 119 (06) 1903-1910
• 38 Minelli L, Callan PP. Inverted-V deformity: an anatomic study. Aesthet Surg J 2023; 43 (03) 290-294
• 39 Kridel RWH, Yoon PJ, Koch RJ. Prevention and correction of nasal tip bossae in rhinoplasty. Arch Facial Plast Surg 2003; 5 (05) 416-422
• 40 Gillman GS, Simons RL, Lee DJ. Nasal tip bossae in rhinoplasty. Etiology, predisposing factors, and management techniques. Arch Facial Plast Surg 1999; 1 (02) 83-89
• 41 Anderson J. The dynamics of rhinoplasty. In: Proceedings of the Ninth International Congress of Otolaryngology. Amsterdam (The Netherlands): Excerpta Medica; Published online 1969
• 42 Tebbetts JB. Shaping and positioning the nasal tip without structural disruption: a new, systematic approach. Plast Reconstr Surg 1994; 94 (01) 61-77
• 43 Oliaei S, Manuel C, Protsenko D, Hamamoto A, Chark D, Wong B. Mechanical analysis of the effects of cephalic trim on lower lateral cartilage stability. Arch Facial Plast Surg 2012; 14 (01) 27-30
• 44 Nagarkar P, Stark RY, Pezeshk RA, Amirlak B, Rohrich RJ. Role of the cephalic trim in modern rhinoplasty. Plast Reconstr Surg 2016; 137 (01) 89-96
• 45 Abdelwahab M, Patel P, Kandathil CK, Wadhwa H, Most SP. Effect of lateral crural procedures on nasal wall stability and tip aesthetics in rhinoplasty. Laryngoscope 2021; 131 (06) E1830-E1837