PMID- 29319787
OWN - NLM
STAT- MEDLINE
DCOM- 20190610
LR  - 20190613
IS  - 1527-330X (Electronic)
IS  - 1090-820X (Linking)
VI  - 38
IP  - 2
DP  - 2018 Feb 17
TI  - Dorsal Preservation: The Push Down Technique Reassessed.
PG  - 117-131
LID - 10.1093/asj/sjx180 [doi]
AB  - Management of the nasal dorsum remains a challenge in rhinoplasty surgery. 
      Currently, the majority of reduction rhinoplasties results in destruction of the 
      keystone area (K-area), which requires reconstruction with either spreader grafts 
      or spreader flaps, both for aesthetic and functional reasons. This article will 
      present the senior author's current operative technique for dorsal preservation 
      in reduction rhinoplasty based on 320 clinical cases performed over a 5-year 
      period. The author's operative technique is as follows: (1) endonasal approach; 
      (2) removal of a septal strip in the subdorsal area whose shape and height were 
      determined preoperatively; (3) complete lateral, transverse, and radix 
      osteotomies; and (4) dorsal reduction utilizing either a push down operation 
      (PDO) or a let down operation (LDO). The PDO consists of downward impaction of 
      the fully mobilized nasal pyramid and is utilized in patients with smaller humps 
      (Less than 4 mm). The LDO consists of a maxillary wedge resection and is 
      performed in patients who need more than 4 mm of lowering. A total of 320 
      patients had a dorsal preservation operation (DPO). Postoperatively, there were 
      no dorsal irregularities nor inverted-V deformities. Among our 44 personal 
      revision cases, 27 patients (8.74%) had had a previous DPO, 16 of whom required 
      tip revisions with no further dorsal surgery. Of the remaining 11 patients, the 
      main problems were either hump recurrence and/or lateral deviation of the dorsum 
      or widening of the middle third, which required simple surgical revision. Based 
      on the authors' experience, adoption of a PDO/LDO is justified in selected 
      primary patients. The key question before any primary rhinoplasty procedure 
      should be "Can I keep the nasal dorsum intact?" Precise analysis and surgical 
      execution are required to preserve the dorsal osseocartilaginous vault and 
      K-area. Dorsal preservation results in more natural postoperative dorsum lines 
      and a "not operated" aspect without the need for midvault reconstruction. 
      Moreover, this technique is quick and easy to perform by any rhinoplasty surgeon. 
      Rhinoplasty surgeons should consider incorporating dorsal preservation techniques 
      in their surgical armamentarium rather than relying solely on the Joseph 
      reduction method or an open structure rhinoplasty.
CI  - (c) 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and 
      permission: journals.permissions@oup.com.
FAU - Saban, Yves
AU  - Saban Y
AD  - private practice in Nice, France.
FAU - Daniel, Rollin K
AU  - Daniel RK
AD  - Department of Plastic Surgery, University of California, Irvine School of 
      Medicine, Irvine, CA.
AD  - Rhinoplasty Section Co-editor for Aesthetic Surgery Journal.
FAU - Polselli, Roberto
AU  - Polselli R
AD  - private practice in Massa Carrara, Italy.
FAU - Trapasso, Maria
AU  - Trapasso M
AD  - ICCS Citta Studi, Plastic and Reconstructive Surgery Unit, Milan, Italy.
FAU - Palhazi, Peter
AU  - Palhazi P
AD  - Department of Plastic Surgery, University of Pecs Medical School, Pecs, Hungary.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Aesthet Surg J
JT  - Aesthetic surgery journal
JID - 9707469
SB  - IM
CIN - Aesthet Surg J. 2018 Feb 17;38(2):132. PMID: 29319783
CIN - Aesthet Surg J. 2019 Nov 13;39(12):NP547-NP549. PMID: 31724032
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - *Esthetics
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Nasal Cartilages/anatomy & histology/surgery
MH  - Nasal Septum/anatomy & histology/surgery
MH  - Osteotomy/*methods
MH  - *Patient Satisfaction
MH  - Rhinoplasty/*methods
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2018/01/11 06:00
MHDA- 2019/06/14 06:00
CRDT- 2018/01/11 06:00
PHST- 2018/01/11 06:00 [pubmed]
PHST- 2019/06/14 06:00 [medline]
PHST- 2018/01/11 06:00 [entrez]
AID - 4793294 [pii]
AID - 10.1093/asj/sjx180 [doi]
PST - ppublish
SO  - Aesthet Surg J. 2018 Feb 17;38(2):117-131. doi: 10.1093/asj/sjx180.