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

[BACKGROUND] 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.

[METHODS] 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).

[RESULTS] 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.

[CONCLUSION] 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.