Facial Plast Surg 2021; 37(01): 081-085
DOI: 10.1055/s-0041-1722910
Original Article

Preservation Rhinoplasty: Evolution and Current State of Practice in the United States

Priyesh N. Patel
1   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN
,
Oren Friedman
2   Department of Otorhinolaryngology—Head and Neck Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
,
Cherian K. Kandathil
3   Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California
,
Sam P. Most
3   Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California
› Institutsangaben

Abstract

Classic Joseph hump reduction techniques have been a hallmark of current rhinoplasty practice and teaching. Recently, there has been a renewed global interest in preservation rhinoplasty techniques, although these techniques are not new. The work and techniques of innovative surgeons including Goodale, Lothrop, and Cottle describing preservation concepts from the late nineteenth century and early twentieth century were not as prevalently adopted as open structural approaches. As such, there has been a relative paucity in both research and teaching of preservation techniques—particularly in the United States. A survey of members of the American Academy of Facial Plastic and Reconstructive Surgery and The Rhinoplasty Society (145 respondents) demonstrates that while 15 (10%) of surgeons are not at all familiar with dorsal preservation surgery, 130 (90%) were. In the group that was familiar with dorsal preservation, the majority were only somewhat familiar (84, 65%) with these techniques. Only 11 respondents received any formal training in dorsal preservation techniques during residency or fellowship. 61 (42%) had attended a course or conference in which dorsal preservation techniques were discussed. One-hundred twenty-two survey respondents (84.1%) do not currently implement preservation techniques into their rhinoplasty practice. Twelve (8%) respondents implement it in <25% of cases, 5 (3%) in 25 to 50% of cases, and 6 (4%) in >50% of cases. As research and formal training in preservation rhinoplasty grow, familiarity and implementation of these techniques will likely also grow in the United States.



Publikationsverlauf

Artikel online veröffentlicht:
24. Februar 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Daniel RK. The preservation rhinoplasty: a new rhinoplasty revolution. Aesthet Surg J 2018; 38 (02) 228-229
  • 2 Azizzadeh B, Reilly M. Dorsal hump reduction and osteotomies. Clin Plast Surg 2016; 43 (01) 47-58
  • 3 Cottle MH. John Orlando Roe, pioneer in modern rhinoplasty. Arch Otolaryngol 1964; 80: 22-27
  • 4 Bhattacharya S. Jacques Joseph: father of modern aesthetic surgery. Indian J Plast Surg 2008; 41: S3-S8
  • 5 Toriumi D. Structure Rhinoplasty: Lessons Learned in 30 Years. Chicago, IL: DMT Publishers; 2018
  • 6 Goodale JL. A new method for the operative correction of exaggerated roman nose. Boston Med Surg J 1899; 140: 112
  • 7 Goodale JL. The correction of old lateral displacements of the nasal bones. Boston Med Surg J 1901; 145: 538-539
  • 8 Lothrop O. An operation for correcting the aquiline nasal deformity; the use of new instrument; report of a case. Boston Med Surg J 1914; 170: 835-837
  • 9 G M. Chirurgie maxilla-faciale. Paris: Le François; 1940: 1127-1133
  • 10 Sebileau P, Dufourmentel L. Correction chirurgicale des difformités congénitales et acquises de la pyramide nasale. Paris: Arnette; 1926: 104-105
  • 11 S F. The Surgery of Injury and Plastic Repair. Baltimore: The Williams & Wilkins Company; 1939
  • 12 Cottle MH, Loring RM. Corrective surgery of the external nasal pyramid and the nasal septum for restoration of normal physiology. Ill Med J 1946; 90: 119-135
  • 13 Drumheller GW. The Push Down Operation and Septal Surgery. Boston: Little, Brown, and Company; 1973
  • 14 Huizing EH. Push-down of the external nasal pyramid by resection of wedges. Rhinology 1975; 13 (04) 185-190
  • 15 Wayoff M, Perrin C. [Global mobilization of the nasal pyramid according to Cottle's technic: its possibilities in functional nose surgery]. Acta Otorhinolaryngol Belg 1968; 22 (06) 675-680
  • 16 Pirsig W, Königs D. Wedge resection in rhinosurgery: a review of the literature and long-term results in a hundred cases. Rhinology 1988; 26 (02) 77-88
  • 17 Willemot J, Vrebos J, Pollet J, Lalardrie JP. [Plastic surgery and otorhinolaryngology]. Acta Otorhinolaryngol Belg 1967; 21: 463-732
  • 18 Barelli PA. Long term evaluation of “push down” procedures. Rhinology 1975; 13 (01) 25-32
  • 19 Hinderer KH. Fundamentals of Anatomy and Surgery of the Nose. Ann Arbor (Michigan): Aesculapius Publishing Co; 1971
  • 20 Kienstra M, Sherris D, Kern EB. The Cottle vs Joseph Rhinoplasty. In: Larrabee W, Thomas R. eds. Facial Plastic Surgery Clinics of North America. Philadelphia, PA: W.B. Saunders; 1999: 279-294
  • 21 Gola R, Nerini A, Laurent-Fyon C, Waller PY. [Conservative rhinoplasty of the nasal canopy]. Ann Chir Plast Esthet 1989; 34 (06) 465-475
  • 22 Gola R. Functional and esthetic rhinoplasty. Aesthetic Plast Surg 2003; 27 (05) 390-396
  • 23 Saban Y, Braccini F, Polselli R. [Rhinoplasty: morphodynamic anatomy of rhinoplasty. Interest of conservative rhinoplasty]. Rev Laryngol Otol Rhinol (Bord) 2006; 127 (1-2): 15-22
  • 24 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
  • 25 Montes-Bracchini JJ. Nasal profile hump reduction using the let-down technique. Facial Plast Surg 2019; 35 (05) 486-491
  • 26 Úlloa FL. Let down technique. Accessed Dec 12, 2019 at: https://www.rhinoplastyarchive.com/articles/let-down-technique
  • 27 Tuncel U, Aydogdu O. The probable reasons for dorsal hump problems following let-down/push-down rhinoplasty and solution proposals. Plast Reconstr Surg 2019; 144 (03) 378e-385e
  • 28 Santos M, Rego AR, Coutinho M, Sousa CAE, Ferreira MG. Spare roof technique in reduction rhinoplasty: prospective study of the first one hundred patients. Laryngoscope 2019; 129 (12) 2702-2706
  • 29 Ferreira MG, Monteiro D, Reis C, Almeida e Sousa C. Spare roof technique: a middle third new technique. Facial Plast Surg 2016; 32 (01) 111-116
  • 30 Ishida J, Ishida LC, Ishida LH, Vieira JC, Ferreira MC. Treatment of the nasal hump with preservation of the cartilaginous framework. Plast Reconstr Surg 1999; 103 (06) 1729-1733 , discussion 1734–1735
  • 31 Taş S. Dorsal roof technique for dorsum preservation in rhinoplasty. Aesthet Surg J 2020; 40 (03) 263-275
  • 32 Neves JC, Arancibia Tagle D, Dewes W, Larrabee W. The split preservation rhinoplasty: “the Vitruvian Man split maneuver”. European Journal of Plastic Surgery volume. 2020; 43: 323-333
  • 33 Öztürk G. Push-down technique without osteotomy: a new approach. Aesthetic Plast Surg 2020; 44 (03) 891-901
  • 34 Kosins AM. Expanding indications for dorsal preservation rhinoplasty with cartilage conversion techniques. Aesthet Surg J 2021; 41 (02) 174-184
  • 35 Kosins AM, Daniel RK. Decision making in preservation rhinoplasty: a 100 case series with one-year follow-up. Aesthet Surg J 2020; 40 (01) 34-48
  • 36 Patel PN, Abdelwahab M, Most SP. A review and modification of dorsal preservation rhinoplasty techniques. Facial Plast Surg Aesthet Med 2020; 22 (02) 71-79
  • 37 Abdelwahab MA, Neves CA, Patel PN, Most SP. Impact of dorsal preservation rhinoplasty versus dorsal hump resection on the internal nasal valve: a quantitative radiological study. Aesthetic Plast Surg 2020; 44 (03) 879-887
  • 38 Kern EB. History of dorsal preservation surgery: seeking our historical godfather(s) for the “Push Down” and “Let Down” Operations. Facial Plastic Surgery Clinics: Preservation Rhinoplasty 2020; In press
  • 39 Patel PN, Abdelwahab M, Most SP. Dorsal preservation rhinoplasty: method and outcomes of the modified subdorsal strip method. Facial Plast Surg Clin North Am 2021; 29 (01) 29-37