Wells Michael W, DeLeonibus Anthony, Barzallo Devin, Chang Irene A, Swanson Marco, Guyuron Bahman
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
Aesthetic Plast Surg. 2023 Aug;47(4):1488-1493. doi: 10.1007/s00266-023-03345-8. Epub 2023 May 2.
The underlying principles of preservation rhinoplasty (PR) center around maintaining the soft tissue envelope, dorsum, and alar cartilage through surgical manipulations and tip suture techniques. In particular, the let-down (LD) and push-down (PD) techniques have been described, although reports of indications and outcomes in the literature are sparse.
A systematic review of the literature was performed using search terms "preservation" OR "let down" OR "push down" AND "rhinoplasty" on PubMed, Cochrane, SCOPUS, and EMBASE databases. Patient demographic information, operative details, and surgical outcomes were recorded. Sub-cohorts for patients who underwent LD and PD techniques were analyzed utilizing Fischer's exact test for categorical variables and Student's t test for continuous variables.
Overall, there were 5967 PR patients in 30 studies in the final analysis, with 307 patients in the PD cohort and 529 patients in the LD cohort. The Rhinoplasty Outcome Evaluation Questionnaire showed a significant increase of patient satisfaction after PR compared to before PR (62.13 vs 91.14; p < 0.001). There was a significantly lower rate of residual dorsal hump or recurrence of 1.3% (n = 4) in the PD when compared to 4.6% (n = 23) in LD cohorts (p = 0.02). The revision rate of PD (0%, n = 0) was also significantly lower than that of LD (5.0%, n = 25) (p < 0.001).
Based on these published articles, it seems that preservation rhinoplasty is safe and efficacious procedure with improved dorsal aesthetic lines, reduced dorsal contour irregularities, and claimed excellent patient satisfaction. In particular, the PD technique has fewer reported complications and revisions than LD approach, although PD is often indicated in patients with smaller dorsal humps.
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保留性鼻整形术（PR）的基本原则是通过手术操作和鼻尖缝合技术来维持软组织包膜、鼻背和鼻翼软骨。特别是，已经描述了下拉（LD）和下压（PD）技术，尽管文献中关于适应症和结果的报道很少。
在PubMed、Cochrane、SCOPUS和EMBASE数据库上使用搜索词“保留”或“下拉”或“下压”以及“鼻整形术”对文献进行系统回顾。记录患者的人口统计学信息、手术细节和手术结果。对接受LD和PD技术的患者亚组进行分析，分类变量采用Fisher精确检验，连续变量采用学生t检验。
总体而言，最终分析的30项研究中有5967例PR患者，PD队列中有307例患者，LD队列中有529例患者。鼻整形术结果评估问卷显示，与PR前相比，PR后患者满意度显著提高（62.13对91.14；p < 0.001）。与LD队列中的4.6%（n = 23）相比，PD队列中残留鼻背驼峰或复发率显著更低，为1.3%（n = 4）（p = 0.02）。PD的修复率（0%，n = 0）也显著低于LD（5.0%，n = 25）（p < 0.001）。
基于这些已发表的文章，保留性鼻整形术似乎是一种安全有效的手术，可改善鼻背美学线条，减少鼻背轮廓不规则，并获得良好的患者满意度。特别是，PD技术报告的并发症和修复比LD方法少，尽管PD通常适用于鼻背驼峰较小的患者。
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