Fads, Progress, and Paradigm Shifts

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      Anthony P. Sclafani, MD, MBA, FACS, Consulting Editor
      Along a similar timeline, modern rhinoplasty developed to reduce large noses. John Orlando Roe described correction of the “pug nose” deformity in 1887 and a dorsal reduction in 1891. Weir performed dorsal reduction on a patient in 1892. Jacques Joseph performed his first rhinoplasty in 1898 and published his first text on rhinoplasty in 1912. These surgeons highlighted the technique of dorsal reduction and resection to correct large noses. Concurrently, Goodale performed the first dorsal preservation rhinoplasty in 1898. Others followed, but particularly after the publication of Joseph’s textbook, dorsal reduction was ascendant, and dorsal preservation was infrequently performed. While the external approach to rhinoplasty was initiated by Rethi’s description of the columellar incision in 1921, endonasal rhinoplasty remained the predominant method approach to rhinoplasty.
      History is rarely simple and linear. With the advent of a digital society in the 1970s, direct current has risen to greater importance, as it provides the storable, highly stable, low-voltage current required by personal electronics, such as computers and cellphones, and yes, even electric vehicles. With the work of Padovan and Goodman in the 1970s, external approach rhinoplasty steadily became more common. Subsequent work by Johnson and Toriumi emphasized the importance of structural integrity in rhinoplasty performed through the external approach. The work of Saban and others over the past 15 years in understanding and refining dorsal preservation rhinoplasty has once again brought it to the fore, and patients now frequently present to the office requesting “preservation” surgery. What is old is new again, facilitated by an enhanced understanding of the nose.
      It is still quite unclear if we stand at an inflection point in rhinoplasty. I do not seek to give pride of place to one or the other technique. However, a wider, more informed perspective on nasal surgery is of value to any rhinoplasty surgeon. We are at our best when we integrate and synthesize new and old, creating and delivering to our patients the most effective treatments we can tailor to each individual. “Different” need not mean “opposing.”
      Dr Toriumi has assembled in this issue of Facial Plastic Surgery Clinics of North America an outstanding group of authors who describe their viewpoints and preservation rhinoplasty techniques to provide their patients with outstanding results. These authors provide clear, honest, and frank descriptions of their patient selection and preservation techniques. You may or may not embrace this philosophy and technique, but a better understanding of preservation rhinoplasty will enhance your understanding of the art and science of rhinoplasty. I implore you to keep an open mind, read and enjoy this issue—it is a “must read” for every rhinoplasty surgeon!