Szychta Pawel, Robotti Enrico
Private Practice, Dr Szychta Clinic chirurgiaplastyczna.pl, Gdansk, Poland.
Private Practice, Villa Sant'Apollonia, Via Motta 37, Bergamo, Italy.
Aesthetic Plast Surg. 2025 Mar;49(5):1239-1245. doi: 10.1007/s00266-024-04317-2. Epub 2024 Aug 22.
Primary or secondary dorsal augmentation rhinoplasty addresses aesthetic and functional issues related to a deficient, under-projected, or depressed nasal dorsum, frequently in middle vault. Traditional treatments often involve costal cartilage grafts, which can result in palpable irregularities and additional morbidity. Implementing dorsal preservation techniques in selected patients may improve predictability and outcomes of dorsal augmentation.
We conducted a case series involving 12 patients with saddle nose deformities and significant nasal function impairment. All patients underwent either "push-up" preservation technique or "modified dorsal split extended push-up" technique. The techniques were evaluated for feasibility, safety, and efficacy. Functional outcomes were assessed using the nasal obstruction symptom evaluation (NOSE) scale preoperatively and three months postoperatively.
Eight patients underwent "push-up" technique, and four patients required "dorsal split extended push-up" technique due to extensive scarring and mucosal adhesions from previous surgeries. All patients demonstrated significant postoperative improvement in nasal function as indicated by a reduction in NOSE scores (p < 0.05). Aesthetic outcomes showed a naturally augmented and smooth dorsum with no palpable irregularities. Patient satisfaction was rated very high (9 or 10 out of 10) in 10 patients and high (7 or 8 out of 10) in 2 patients. Follow-up was 6 months.
"Push-up" preservation technique and its extended variant provide a new surgical alternative for primary and secondary rhinoplasty with costal cartilage. These techniques offer improved and highly predictable aesthetic outcomes of the nasal dorsum with decreased morbidity, demonstrating significant potential for clinical practice and future research.
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一期或二期鼻背增高隆鼻术可解决与鼻背缺陷、发育不良或凹陷相关的美学和功能问题，常见于鼻中段。传统治疗通常采用肋软骨移植，这可能导致可触及的不规则以及额外的并发症。在部分患者中实施鼻背保留技术可能会提高鼻背增高的可预测性和效果。
我们开展了一项病例系列研究，纳入12例鞍鼻畸形且伴有严重鼻功能障碍的患者。所有患者均接受了“上推”保留技术或“改良鼻背劈开上推扩展”技术。对这些技术的可行性、安全性和有效性进行了评估。术前及术后3个月使用鼻阻塞症状评估（NOSE）量表评估功能结果。
8例患者接受了“上推”技术，4例患者因既往手术导致广泛瘢痕形成和黏膜粘连而需要“鼻背劈开上推扩展”技术。所有患者术后鼻功能均有显著改善，表现为NOSE评分降低（p < 0.05）。美学效果显示鼻背自然增高且光滑，无可触及的不规则。10例患者的患者满意度评分为非常高（10分制中的9或10分），2例患者评分为高（10分制中的7或8分）。随访时间为6个月。
“上推”保留技术及其扩展变体为一期和二期肋软骨隆鼻术提供了一种新的手术选择。这些技术可改善鼻背美学效果且具有高度可预测性，同时降低并发症发生率，在临床实践和未来研究中显示出巨大潜力。
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