Preservation Rhinoplasty Merges with Structure Rhinoplasty

Preservation rhinoplasty is making a resurgence worldwide as surgeons see the benefits of minimizing disruption of key anatomic structures of the nose. The descriptive title, “preservation rhinoplasty,” was coined by Rollin K. Daniel, and he and other leaders have initiated a resurgence in recent years. Preservation rhinoplasty encompasses a subperichondrial/subperiosteal dissection plane with preservation of the ligamentous supportive structures, maintenance of the alar cartilages integrity with reshaping performed primarily through tip suturing, and preserving the natural nasal dorsum with possible minor surface modification without creating an “open roof deformity.” Dorsal preservation was initially introduced many years ago by Goodale in 1899, Lothrop in 1914, and Cottle in 1946. Wilson Dewes described the Septum Pyramidal Adjustment and Repositioning (SPAR A, B, and C) technique in 2013. Most would agree that Yves Saban led the present resurgence of dorsal preservation. There have been instances where dorsal preservation was promoted in the past with less than enthusiastic fervor. What appears to be different in this movement is that expert surgeons experienced in dorsal preservation are getting outstanding results consistently and are making an effort to teach the techniques worldwide. With the onset of COVID-19 and lockdowns, many of these prominent surgeons were able to spread the message about dorsal preservation through online webinars open to anyone who was interested.

There were multiple lineages where dorsal preservation was taught. These schools taught many surgeons who have become present-day leaders in the preservation movement. Many of these surgeons have contributed to this issue of the Facial Plastic Surgery Clinics of North America. I am pleased to have the opportunity to get to know this group of individuals and to learn from those who came from the different lineages (Pinto, Dewes, Ishida, Lopez, Gola, Sulcenti, Saban, Ignacio, Tasca, Carbajal, deLuca, and so forth).

With this present-day resurgence of dorsal preservation, surgeons introduced new innovative techniques to manage the dorsal hump. In this issue, most all the different techniques will be covered. Sam Most provides an overview of dorsal preservation and discusses his approach to the intermediate strip. Yves Saban discusses the high strip and provides his long-term outcomes using this technique. Baris Cakir describes his technique and how he performs endonasal preservation rhinoplasty. Miguel Ferreira discusses the spare roof technique and surface modifications to manage the dorsal hump. Abdulkadir Goksel presents his methods using the open approach and the impact of the “Ballerina maneuver.” I discuss my early experience with dorsal preservation, pointing out important nuances to help those who are just starting with this approach. Valerio Finocchi covers his SPQR technique and provides specific details on how to execute this technique effectively. Milos Kovacevic and I discuss how the subdorsal cantilever graft can be used in dorsal preservation. Mario Ferraz discusses the Brazilian approach and SPAR and the many lineages of dorsal preservation. Olivier Gerbault provides a clear perspective on piezo technology and how he uses it in his practice.

I am honored to be able to bring this talented group of rhinoplasty surgeons together to teach us all about the nuances of dorsal preservation.