Download PDF
Facial Plast Surg 2023; 39(04): 441-451
DOI: 10.1055/a-2034-8272
Original Article

Modified Dorsal Split Preservation Hybrid Rhinoplasty for Cartilaginous Pushdown and Full Letdown Applications: A PROM-Based Review of 100 Consecutive Cases

Enrico Robotti
1   Department of Plastic Surgery, Villa Sant'Apollonia Private Health Clinic, Bergamo, Lombardia, Italy
,
Giuseppe Cottone 
2   Department of Plastic and Reconstructive Surgery, Università degli Studi di Milano, Milano, Milan, Italy
,
Francesco Leone
1   Department of Plastic Surgery, Villa Sant'Apollonia Private Health Clinic, Bergamo, Lombardia, Italy
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Splitting the middle vault on an anatomical plane along the “Septal T” allows a new hybrid perspective on the many modifications of “surface” preservation techniques. The “dorsal split preservation” concept can be applied both to cartilaginous pushdown as well as to full letdown techniques. The dorsal keystone area is maintained, while the middle vault is reshaped. The septum is addressed by conventional L strut septoplasty. Precise direct suture fixation of the high-middle strip is easily accomplished after flexing the osseous-chondral junction at the K area. Specific technical points are described to allow exact and stable configuration of the dorsum.

A retrospective analysis on 100 consecutive patients demonstrated aesthetic and functional improvement.

Keywords

rhinoplasty - preservation rhinoplasty - pushdown - nasal dorsum


Publication History

Accepted Manuscript online:
14 February 2023

Article published online:
27 March 2023

© 2023. 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
    Google Scholar
  • 2 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
    Google Scholar
  • 3 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
    CrossrefPubMedGoogle Scholar
  • 4 Patel PN, Most SP. Overview of dorsal preservation rhinoplasty. Facial Plast Surg Clin North Am 2023; 31 (01) 1-11
    CrossrefPubMedGoogle Scholar
  • 5 Neves JC. Preservation rhinoplasty: an update. Facial Plast Surg 2021; 37 (01) 1
    Google Scholar
  • 6 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
    CrossrefPubMedGoogle Scholar
  • 7 Gonçalves Ferreira M, Toriumi DM. A practical classification system for dorsal preservation rhinoplasty techniques. Facial Plast Surg Aesthet Med 2021; 23 (03) 153-155
    CrossrefPubMedGoogle Scholar
  • 8 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
    CrossrefPubMedGoogle Scholar
  • 9 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Ishida LC, Ishida J, Ishida LH, Tartare A, Fernandes RK, Gemperli R. Nasal hump treatment with cartilaginous push-down and preservation of the bony cap. Aesthet Surg J 2020; 40 (11) 1168-1178
    Google Scholar
  • 11 Ferreira MG, Santos M. Surface techniques in dorsal preservation. Facial Plast Surg Clin North Am 2023; 31 (01) 45-57
    CrossrefPubMedGoogle Scholar
  • 12 Gerbault O, Daniel RK, Kosins AM. The role of piezoelectric instrumentation in rhinoplasty surgery. Aesthet Surg J 2016; 36 (01) 21-34
    CrossrefPubMedGoogle Scholar
  • 13 Goksel A, Saban Y. Open piezo preservation rhinoplasty: a case report of the new rhinoplasty approach. Facial Plast Surg 2019; 35 (01) 113-118
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Patel PN, Most SP. Combining open structural and dorsal preservation rhinoplasty. Clin Plast Surg 2022; 49 (01) 97-109
    CrossrefPubMedGoogle Scholar
  • 15 Toriumi DM, Kovacevic M, Kosins AM. Structural preservation rhinoplasty: a hybrid approach. Plast Reconstr Surg 2022; 149 (05) 1105-1120
    CrossrefPubMedGoogle Scholar
  • 16 Robotti E, Chauke-Malinga NY, Leone F. A modified dorsal split preservation technique for nasal humps with minor bony component: a preliminary report. Aesthetic Plast Surg 2019; 43 (05) 1257-1268
    CrossrefPubMedGoogle Scholar
  • 17 Robotti E, Choc IS, Jaber O. Use of the “Septal T” as a spacer and conformer for a properly contoured nasal tip in rhinoplasty. Aesthet Surg J 2017; 37 (01) 122-127
    CrossrefPubMedGoogle Scholar
  • 18 Daniel RK, Palhazi P. Rhinoplasty: An Anatomical and Clinical Atlas. Berlin: Springer; 2018: 122-123
    CrossrefGoogle Scholar
  • 19 Sadri A, East C, Badia L, Saban Y. Dorsal preservation rhinoplasty: core beam computed tomography analysis of the nasal vault, septum, and skull base—its role in surgical planning. Facial Plast Surg 2020; 36 (03) 329-334
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Robotti E, Daniel RK, Leone F. Cone-beam computed tomography: a user-friendly, practical roadmap to the planning and execution of every rhinoplasty-a 5-year review. Plast Reconstr Surg 2021; 147 (05) 749e-762e
    CrossrefPubMedGoogle Scholar
  • 21 Palhazi P, Daniel RK, Kosins AM. The osseocartilaginous vault of the nose: anatomy and surgical observations. Aesthet Surg J 2015; 35 (03) 242-251
    CrossrefPubMedGoogle Scholar
  • 22 Lazovic GD, Daniel RK, Janosevic LB, Kosanovic RM, Colic MM, Kosins AM. Rhinoplasty: the nasal bones - anatomy and analysis. Aesthet Surg J 2015; 35 (03) 255-263
    CrossrefPubMedGoogle Scholar
  • 23 Ferreira MG, Dias DR, Cardoso L. et al. Dorsal hump reduction based on the new ethmoidal point classification: a clinical and radiological study of the keystone area in 138 patients. Aesthet Surg J 2020; 40 (09) 950-959
    CrossrefPubMedGoogle Scholar
  • 24 Kosins AM. Expanding indications for dorsal preservation rhinoplasty with cartilage conversion techniques. Aesthet Surg J 2021; 41 (02) 174-184
    CrossrefPubMedGoogle Scholar
  • 25 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
    CrossrefPubMedGoogle Scholar
  • 26 Neves JC, Arancibia Tagle D, Dewes W, Larrabee Jr W. The split preservation rhinoplasty: “the Vitruvian Man split maneuver”. Eur J Plast Surg 2020; 43: 323-33
    CrossrefPubMedGoogle Scholar
  • 27 Neves JC, Arancibia-Tagle D. Avoiding aesthetic drawbacks and stigmata in dorsal line preservation rhinoplasty. Facial Plast Surg 2021; 37 (01) 65-75
    Google Scholar
  • 28 Furtado S. Hybrid preservation rhinoplasty with dorsal split modification. Paper presented at: Seventh Bergamo Open Rhinoplasty Course, March 24–26, Bergamo, Italy
    PubMedGoogle Scholar
  • 29 Battista RA, Ferraro M, Piccioni LO. et al. Translation, cultural adaptation and validation of the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) [in Italian]. Aesthetic Plast Surg 2022; 46 (03) 1351-1359
    CrossrefPubMedGoogle Scholar
  • 30 Moubayed SP, Ioannidis JPA, Saltychev M, Most SP. The 10-item standardized cosmesis and health nasal outcomes survey (SCHNOS) for functional and cosmetic rhinoplasty. JAMA Facial Plast Surg 2018; 20 (01) 37-42
    Google Scholar
  • 31 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
    CrossrefPubMedGoogle Scholar
  • 32 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
    CrossrefPubMedGoogle Scholar
  • 33 Sousa Vieira A, Milicic D, Torrão Pinheiro C, Carvalho G. Extended dorsal preservation in a new concept of preservational rhinoplasty. Ann Plast Reconstr Surg. 2020; 4 (02) 1055
    PubMedGoogle Scholar
  • 34 Ferreira MG, Santos M, Carmo DOE, Neves JC, Sousa CAE, Datema FR. Rhinoplasty: do patients and surgeons see thesame? A double-blind study with 100 randomized patients. Facial Plast Surg 2018; 34 (04) 356-362
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Tham T, Bhuiya S, Wong A, Zhu D, Romo T, Georgolios A. Clinical outcomes in dorsal preservation rhinoplasty: a meta-analysis. Facial Plast Surg Aesthet Med 2022; 24 (03) 187-194
    CrossrefPubMedGoogle Scholar
  • 36 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
    CrossrefPubMedGoogle Scholar
  • 37 Patel PN, Abdelwahab M, Most SP. Combined functional and preservation rhinoplasty. Facial Plast Surg Clin North Am 2021; 29 (01) 113-121
    CrossrefPubMedGoogle Scholar
  • 38 Ferreira MG, Santos M, Carmo DOE. et al. Spare roof technique versus component dorsal hump reduction: a randomized prospective study in 250 primary rhinoplasties, aesthetic and functional outcomes. Aesthet Surg J 2021; 41 (03) 288-300
    CrossrefPubMedGoogle Scholar
  • 39 Stergiou G, Fortuny CG, Schweigler A, Finocchi V, Saban Y, Tremp M. A multivariate analysis after preservation rhinoplasty (PR) - a prospective study. J Plast Reconstr Aesthet Surg 2022; 75 (01) 369-373
    CrossrefPubMedGoogle Scholar
  • 40 Robotti E, Leone F, Malfussi VA, Cottone G. The “3 Points Compartmentalization” technique in subperichondrial-subperiosteal dissection in primary rhinoplasty to reduce edema and define contour. Aesthetic Plast Surg 2022; 46 (04) 1923-1931
    CrossrefPubMedGoogle Scholar