Dorsal preservation versus dorsal reduction rhinoplasty techniques for aesthetic and functional outcomes: a systematic review and meta-analysis.

Abstract

The differences in outcomes between dorsal preservation (DP) and dorsal reduction (DR) techniques in rhinoplasty remain unclear. This meta-analysis evaluates the DP and DR in terms of functional and aesthetic outcomes, revisions surgeries, dorsal irregularities, and residual and recurrent hump. We searched PubMed, Cochrane, and Embase up to January 20th, 2025, for studies comparing DP versus DR. Primary outcome was standardized functional scores in the long-term postoperative period. Secondary outcomes were: short-term standardized functional outcomes, subjective aesthetic outcomes (sort-term and long-term), long-term standardized aesthetic outcome and total SCHNOS, revisions surgeries needed, dorsal irregularities, and residual and recurrent hump. Subgroup analyses were performed to evaluate different scales (SCHNOS, NOSE, VAS and UQ). Ten studies (1339 patients) were included. DP showed a significantly higher satisfaction in the UQ subgroup for short-term subjective aesthetic outcome (MD 1.13 points [95% CI: 0.74-1.52]; p < 0.001; I² = 0%), a significant reduction in dorsal irregularities (RR 0.28 [95% CI: 0.10-0.78]; p = 0.01; I² = 0%), and a significantly higher rate of residual and recurrent hump (RR 2.94 [95% CI: 1.23-7.03]; p = 0.02; I² = 0%), compared to the DR group. No significant differences were found in standardized functional outcomes, subjective aesthetic outcomes, standardized aesthetic outcomes, total SCHNOS, or revision surgeries. DP was associated with greater short-term aesthetic satisfaction (UQ), fewer dorsal irregularities, and a higher risk of residual and recurrent hump compared to DR. There were no significant differences between the groups in the other outcomes.