Preservation rhinoplasty has been a trending topic in the rhinoplasty literature. There is no single technique that can correct all structures; therefore, patient analysis is paramount. This article focuses on the anatomy of the keystone area and the dynamics of the dorsum explained through the biotensegrity concept. Differences between push-down and let-down techniques are addressed from a nasal valve physiology point of view. The let-down technique maintains the tensegrity of the nasal pyramid. Preservation should be preferred, in most cases, over resection, as well as reposition over manipulation.
Keywords: Biotensegrity; Dorsal reduction; Endonasal; Let down; Nasal valve; Preservation rhinoplasty.
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