The Process of Single Surgeon Through Structural and Dorsal Preservation in Primary Rhinoplasty: A 594 Case Series with One-Year Follow-Up.

Background: Dorsal management is a challenging step in rhinosurgery. In the last decade, an old philosophy of preserving the dorsum has gained popularity alongside the traditional hump resection proposed by Joseph. This study aims to investigate the journey of a rhinosurgeon transitioning from structural to dorsal preservation techniques in primary rhinoplasty.

Methods: A retrospective study was conducted on 594 consecutive patients who underwent primary rhinoplasty by the main surgeon (R.T.) with at least 12 months of follow-up. All surgeries were categorized based on the dorsal approach into Structural Dorsal Rhinoplasty (SDR), Partial Dorsal Preservation Rhinoplasty (PDPR), and Total Dorsal Preservation Rhinoplasty (TDPR). The three groups were compared based on the following variables: operative time, long-term complication rate, and re-intervention rate.

Results: The study included 67 males and 527 females, with an average age of 31.43 years. The average anesthesia operative times were 231.30 minutes for SDR, 241.74 minutes for PDP, and 230.32 minutes for TDP, with no statistically significant differences observed. The complication and revision rates were as follows: SDR had 12.74% complications and 7.32% revisions, PDPR had 13.37% complications and 3.82% revisions, and TDPR had 10.57% complications and 3.25% revisions. Hump recurrence rates were 2.54% in SDR, 7.64% in PDPR, and 6.50% in TDPR. Contour irregularities occurred in 9.55% of SDR, 5.09% of PDPR, and 2.44% of TDPR cases. Both hump recurrence and contour irregularities showed statistically significant differences among the three groups.

Conclusion: This study analyzed how the aforementioned variables change during the transition from structural to dorsal preservation techniques, considering the latter as the natural evolution in rhinoplasty.

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