Purpose of review: The philosophy of preservation rhinoplasty originated 100 years ago. Many variations have appeared in the last 10 years, with different opinions emerging in the literature and scientific meetings.
Recent findings: New technological devices (piezo and diamond burs), new anatomical concepts (W and E-points, lateral and dorsal keystone area), and many new surgical strategies have led to a recent revolution in rhinoplasty.
Summary: Preservation rhinoplasty is a surgical strategy/philosophy that has gained popularity among rhinoplasty surgeons. Dorsal preservation rhinoplasty is the 'queen' of preservation rhinoplasty, and an array of surgeons' variations have come about. Ferreira et al. have proposed a classification for dorsal preservation rhinoplasty that splits it into foundation techniques and surface techniques. Foundation techniques are all techniques with impaction osteotomies - push or letdown; in this group, there is always a more minor or significant disruption between the skull and the nasal pyramid. Surface techniques are techniques that work on the surface of the nose (like the traditional structured approaches); in this group, there are no impaction osteotomies, so there is no disruption between the skull and the nose.
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