LAUSR

BACKGROUND Preservation rhinoplasty (PR) is an evolving philosophy. OBJECTIVES The open approach was used initially, but the author felt a closed approach might be of benefit in certain patients. METHODS One hundred sixty-two primary rhinoplasty cases were studied retrospectively between January and July 2020. One hundred cases had at least 1 year of follow-up. Patients had follow-up at 1 week, 1 month, 3 months, and 1 year after surgery. Technical details were recorded including dissection planes, preservation of the dorsum (DP) versus component reductions, surface versus foundational DP techniques, and open versus closed approach. RESULTS One hundred patients had at least 1 year of follow-up. Fifty-six patients underwent an open approach, and 44 a closed approach. Eighty-three patients had preservation of the dorsal soft tissue envelope. All patients having a closed approach had preservation of the dorsal soft tissue envelope. Sixty-seven patients underwent DP with 38 having surface techniques and 29 having impaction techniques. Thirty-three patients underwent structural rhinoplasty with piezoelectric osteotomies and mid-vault reconstruction. All structural cases were performed using an open approach. Four revision surgeries were necessary. CONCLUSIONS Open and closed approaches have indications depending on the tip and dorsal deformities. A closed, PR is favored with thin skin, minimal dorsal modification, osseocartilaginous preservation (foundation techniques), less complex tip deformities, and overprojected noses. An open, PR is favored for extensive dorsal modification, S-shaped nasal bones, complex tip deformities, and tip augmentation. Structural, dorsal rhinoplasty is always done open and preferred for complex dorsal deformities and severe septal deviations.