Matched Cohort Comparison of Dorsal Preservation and Conventional Hump Resection Rhinoplasty

Aesthetic Plast Surg. 2023 Jun;47(3):1119-1129. doi: 10.1007/s00266-022-03156-3. Epub 2022 Oct 31.


Background: Structural preservation techniques (SPR) minimize disruption of the dorsal aesthetic lines, with potential aesthetic and functional benefits over conventional hump resection techniques (CHR). The goal of this study is to compare patient reported outcomes between these techniques.

Methods: This study was a retrospective matched cohort analysis of patients undergoing rhinoplasty with dorsal hump reduction using patient-reported outcomes measures: Standardized Cosmesis and Health Nasal Outcomes Survey (obstructive: SCHNOS-O, cosmetic: SCHNOS-C) and visual analog scale (functional: VAS-F, cosmetic: VAS-C). A cohort of patients undergoing SPR were matched to a cohort undergoing CHR based on age, gender, and preoperative SCHNOS scores. Intraoperative techniques and patient-reported outcomes were compared between groups.

Results: There were no significant differences in the dorsal height between groups. While radix grafting was more common in SPR, dorsal onlay grafting and midvault reconstructive techniques (e.g. autospreader flaps) were more common in CHR. Within both groups, post-operative SCHNOS and VAS improved significantly at short- and long-term follow-up. There were no differences between SCHNOS or VAS scores preoperatively. Post-operative SCHNOS-O and SCHNOS-C scores were similar between groups at both short-term and long-term follow-up. Post-operative VAS-F scores were not different; however, VAS-C scores at short-term follow-up were statistically greater in the SPR group compared to the CHR group (8.92 vs 8.20, p = 0.03). At long-term follow-up, the difference was not significant.

Conclusion: While there are theoretical functional and aesthetic benefits of SPR techniques, the patient reported benefits may be minimal when compared to CHR techniques with appropriate midvault reconstruction.

Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .

Keywords: Dorsal preservation; Hump resection; Let down; Preservation rhinoplasty; Push down.

MeSH terms

  • Esthetics
  • Follow-Up Studies
  • Humans
  • Nasal Septum / surgery
  • Nose / surgery
  • Retrospective Studies
  • Rhinoplasty* / methods
  • Treatment Outcome